Provider Demographics
NPI:1528557964
Name:GALLICK, KATHRIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHRIN
Middle Name:
Last Name:GALLICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RIDGEWOOD DR APT 1206
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3775
Mailing Address - Country:US
Mailing Address - Phone:207-576-1587
Mailing Address - Fax:075-761-5872
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4226
Practice Address - Country:US
Practice Address - Phone:984-974-1485
Practice Address - Fax:984-974-0355
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program