MEDICARE: DR. JOHN C GALLAGHER D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30.023598	OH

General Provider Information

NPI Number	:	1063780047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C GALLAGHER D.D.S

Provider Business Mailing Address
First Line	:	1820 LYONS RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1839
Country	:	US
Telephone Number	:	937-438-3838
Fax Number	:	937-438-3202

Provider Business Practice Location Address
First Line	:	1820 LYONS RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1839
Country	:	US
Telephone Number	:	937-438-3838
Fax Number	:	937-438-3202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	12/06/2011

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