Provider Demographics
NPI:1972287175
Name:GALLAHER, WILLIAM JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JACOB
Last Name:GALLAHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15414 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2528
Mailing Address - Country:US
Mailing Address - Phone:847-826-1577
Mailing Address - Fax:
Practice Address - Street 1:7117 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4851
Practice Address - Country:US
Practice Address - Phone:515-276-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-101011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty