MEDICARE: DR. BRIAN L GALLAGHER DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	3119	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407833668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN L GALLAGHER DMD

Provider Business Mailing Address
First Line	:	211 MOUNT AUBURN AVE
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-8521
Country	:	US
Telephone Number	:	207-514-7171
Fax Number	:	207-514-7177

Provider Business Practice Location Address
First Line	:	211 MOUNT AUBURN AVE
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-8521
Country	:	US
Telephone Number	:	207-514-7171
Fax Number	:	207-514-7177

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	08/22/2007

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