MEDICARE: DR. ALEXIS LEIGH GALLAGHER DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2901022027	MI

General Provider Information

NPI Number	:	1861057119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS LEIGH GALLAGHER DDS, MS

Provider Business Mailing Address
First Line	:	6412 SUMMER MEADOWS DR NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-7101
Country	:	US
Telephone Number	:	517-862-4249
Fax Number	:

Provider Business Practice Location Address
First Line	:	6840 NORTHWAY DR NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-7568
Country	:	US
Telephone Number	:	616-863-0600
Fax Number	:

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

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	05/02/2019

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