Provider Demographics
NPI:1841187093
Name:GAGLIANO, NICHOLAS CHARLES (DMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHARLES
Last Name:GAGLIANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 RIDGE TOP LN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SC
Mailing Address - Zip Code:29676-3243
Mailing Address - Country:US
Mailing Address - Phone:601-466-7565
Mailing Address - Fax:
Practice Address - Street 1:471688 OK-51
Practice Address - Street 2:
Practice Address - City:STILWEL
Practice Address - State:OK
Practice Address - Zip Code:74960
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program