Provider Demographics
NPI:1992185862
Name:GALLOWAY, MADISON MYERS (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:MYERS
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MADISON
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:234 NATCHEZ TRACE AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103
Mailing Address - Country:US
Mailing Address - Phone:270-590-3407
Mailing Address - Fax:
Practice Address - Street 1:234 NATCHEZ TRACE AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103
Practice Address - Country:US
Practice Address - Phone:270-590-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INLDR1501141223P0221X
KY95971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty