Healthcare Provider Details

I. General information

NPI: 1841187093
Provider Name (Legal Business Name): NICHOLAS CHARLES GAGLIANO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471688 OK-51
STILWEL OK
74960
US

IV. Provider business mailing address

162 RIDGE TOP LN
SALEM SC
29676-3243
US

V. Phone/Fax

Practice location:
  • Phone: 918-696-8800
  • Fax:
Mailing address:
  • Phone: 601-466-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: