Provider Demographics
NPI:1063780047
Name:GALLAGHER, JOHN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1839
Mailing Address - Country:US
Mailing Address - Phone:937-438-3838
Mailing Address - Fax:937-438-3202
Practice Address - Street 1:1820 LYONS RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1839
Practice Address - Country:US
Practice Address - Phone:937-438-3838
Practice Address - Fax:937-438-3202
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist