Provider Demographics
NPI:1982930855
Name:GALLAGHER, MAUREEN KATHLEEN (DDS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:KATHLEEN
Last Name:GALLAGHER
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 1:200 CENTRAL PARK S APT 207
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1450
Mailing Address - Country:US
Mailing Address - Phone:212-315-0292
Mailing Address - Fax:212-315-0293
Practice Address - Street 1:200 CENTRAL PARK S APT 207
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1450
Practice Address - Country:US
Practice Address - Phone:212-315-0292
Practice Address - Fax:212-315-0293
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist