Healthcare Provider Details

I. General information

NPI: 1093977506
Provider Name (Legal Business Name): DAVID G. GAILEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 E 29TH AVE SUITE #104
SPOKANE WA
99203-3961
US

IV. Provider business mailing address

2204 E 29TH AVE SUITE #104
SPOKANE WA
99203-3961
US

V. Phone/Fax

Practice location:
  • Phone: 509-321-1404
  • Fax: 509-321-0211
Mailing address:
  • Phone: 509-321-1404
  • Fax: 509-321-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number166
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60353083
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDE60353083
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: