Healthcare Provider Details

I. General information

NPI: 1659393361
Provider Name (Legal Business Name): KULLEN GALLAGHER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HEBRON RD STE E
MARLBOROUGH CT
06447-1272
US

IV. Provider business mailing address

8 HEBRON RD STE E
MARLBOROUGH CT
06447-1272
US

V. Phone/Fax

Practice location:
  • Phone: 860-295-8132
  • Fax: 860-295-8116
Mailing address:
  • Phone: 860-295-8132
  • Fax: 860-295-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number009055
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: