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General NPI Number Information
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NPI Number | 1831686542
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Entity Type | Organization
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Legal Business Name | GLASGOW CHILDREN'S DENTAL CENTER, PLLC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 203 PROFESSIONAL PARK DR
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City | GLASGOW
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State | KY
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Zip | 42141-3486
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Country | US
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Telephone | 270-629-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 203 PROFESSIONAL PARK DR
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City | GLASGOW
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State | KY
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Zip | 42141-3486
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Country | US
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Telephone | 270-629-5437
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. MADISON MYERS GALLOWAY
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Credential | DMD, MSD
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Telephone | 270-590-3407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9597
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License Number State | KY
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