MEDICARE: GALLAGHER VENTURES

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

General Provider Information

NPI Number	:	1417020868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALLAGHER VENTURES

Provider Business Mailing Address
First Line	:	6605 N 19TH AVE
Second Line	:	SUITE D
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1628
Country	:	US
Telephone Number	:	602-997-5096
Fax Number	:	602-944-4380

Provider Business Practice Location Address
First Line	:	6605 N 19TH AVE
Second Line	:	SUITE D
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1628
Country	:	US
Telephone Number	:	602-997-5096
Fax Number	:	602-944-4380

Authorized Official
Title or Position	:	OWNER
Name	:	CAROL GALLAGHER
Credential	:
Telephone Number	:	602-997-5096

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	08/22/2020

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