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General NPI Number Information
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NPI Number | 1861057119
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Entity Type | Individual
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Provider Name | ALEXIS LEIGH GALLAGHER DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 6840 NORTHWAY DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7568
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Country | US
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Telephone | 616-863-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 6412 SUMMER MEADOWS DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7101
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Country | US
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Telephone | 517-862-4249
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901022027
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License Number State | MI
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