Provider Demographics
NPI:1770596280
Name:GALLAGHER, KEVIN DONALD (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DONALD
Last Name:GALLAGHER
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 1:15515 SOUTE ROUTE 59
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2725
Mailing Address - Country:US
Mailing Address - Phone:815-436-2406
Mailing Address - Fax:815-436-2547
Practice Address - Street 1:15515 SOUTE ROUTE 59
Practice Address - Street 2:SUITE 300
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2725
Practice Address - Country:US
Practice Address - Phone:815-436-2406
Practice Address - Fax:815-436-2547
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice