Provider Demographics
NPI:1851452957
Name:GALLAGHER, LAWRENCE F (DMD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:F
Last Name:GALLAGHER
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 1:412 PITTSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-1116
Mailing Address - Country:US
Mailing Address - Phone:570-347-9986
Mailing Address - Fax:570-558-0779
Practice Address - Street 1:412 PITTSTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1116
Practice Address - Country:US
Practice Address - Phone:570-347-9986
Practice Address - Fax:570-558-0779
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0261851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice