Healthcare Provider Details

I. General information

NPI: 1235264656
Provider Name (Legal Business Name): RICHARD T. GALLAGHER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 CHASTANT ST STE A
METAIRIE LA
70006-2088
US

IV. Provider business mailing address

4440 CHASTANT ST STE A
METAIRIE LA
70006-2088
US

V. Phone/Fax

Practice location:
  • Phone: 504-887-0181
  • Fax:
Mailing address:
  • Phone: 504-887-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2133
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: