Provider Demographics
NPI:1063144913
Name:GALEGHER, SHANNON (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:GALEGHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 S FAIRPLAY ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3791
Mailing Address - Country:US
Mailing Address - Phone:701-741-5290
Mailing Address - Fax:
Practice Address - Street 1:4243 E 136TH AVE UNIT 348
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-6918
Practice Address - Country:US
Practice Address - Phone:720-274-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002051641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice