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General NPI Number Information
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NPI Number | 1295927770
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Entity Type | Individual
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Provider Name | MICHAEL GILLOGLY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 6606 FM 1488 RD STE 136
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City | MAGNOLIA
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State | TX
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Zip | 77354-2545
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Country | US
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Telephone | 936-273-9399
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Fax |
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Provider Business Mailing Address
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Address Line | 395 SAWDUST RD PMB 2075
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City | SPRING
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State | TX
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Zip | 77380-2242
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Country | US
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Telephone | 210-831-7394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 23506
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License Number State | TX
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