Provider Demographics
NPI:1750360392
Name:GALE, NICKIE L (DDS)
Entity type:Individual
Prefix:
First Name:NICKIE
Middle Name:L
Last Name:GALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S CLAIRBORNE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1725
Mailing Address - Country:US
Mailing Address - Phone:913-764-6367
Mailing Address - Fax:913-764-6387
Practice Address - Street 1:304 S CLAIRBORNE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1725
Practice Address - Country:US
Practice Address - Phone:913-764-6367
Practice Address - Fax:913-764-6387
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS602111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice