Provider Demographics
NPI:1588735195
Name:GALLAGHER, PATRICK R III (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:R
Last Name:GALLAGHER
Suffix:III
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 1:715 BALTIMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-4552
Mailing Address - Country:US
Mailing Address - Phone:410-857-5660
Mailing Address - Fax:410-875-0891
Practice Address - Street 1:715 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6105
Practice Address - Country:US
Practice Address - Phone:108-575-6604
Practice Address - Fax:410-875-0891
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522256834OtherFED ID #