Provider Demographics
NPI:1841585247
Name:GALLAGHER, AMANDA K (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:K
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 ELLIOT ST
Mailing Address - Street 2:SUITE 195 L
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1157
Mailing Address - Country:US
Mailing Address - Phone:617-527-0880
Mailing Address - Fax:
Practice Address - Street 1:381 ELLIOT ST
Practice Address - Street 2:SUITE 195 L
Practice Address - City:NEWTON UPPER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02464-1157
Practice Address - Country:US
Practice Address - Phone:617-527-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18556441223X0400X
MD143611223X0400X
PADS0375811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics