MEDICARE: DR. KELLY ROBERT GALLAGHER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	MN9264	MN

General Provider Information

NPI Number	:	1295783462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY ROBERT GALLAGHER DDS

Provider Business Mailing Address
First Line	:	216 N BROADWAY
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-3646
Country	:	US
Telephone Number	:	507-289-5838
Fax Number	:	507-536-2762

Provider Business Practice Location Address
First Line	:	216 N BROADWAY
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-3646
Country	:	US
Telephone Number	:	507-289-5838
Fax Number	:	507-536-2762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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