Provider Demographics
NPI:1386709772
Name:LINK, AMY NICOLE GALLAGHER (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:NICOLE GALLAGHER
Last Name:LINK
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 1:126 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1103
Mailing Address - Country:US
Mailing Address - Phone:319-366-8095
Mailing Address - Fax:319-366-4542
Practice Address - Street 1:126 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1103
Practice Address - Country:US
Practice Address - Phone:319-366-8095
Practice Address - Fax:319-366-4542
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice