Provider Demographics
NPI:1861057119
Name:GALLAGHER, ALEXIS LEIGH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:LEIGH
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 SUMMER MEADOWS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7101
Mailing Address - Country:US
Mailing Address - Phone:517-862-4249
Mailing Address - Fax:
Practice Address - Street 1:6840 NORTHWAY DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7568
Practice Address - Country:US
Practice Address - Phone:616-863-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010220271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics