Provider Demographics
NPI:1174765911
Name:GALVAN DENTAL LLC
Entity type:Organization
Organization Name:GALVAN DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:HALILI
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-643-2273
Mailing Address - Street 1:2809 REDWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-3634
Mailing Address - Country:US
Mailing Address - Phone:707-643-2273
Mailing Address - Fax:707-643-4210
Practice Address - Street 1:2809 REDWOOD PKWY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3634
Practice Address - Country:US
Practice Address - Phone:707-643-2273
Practice Address - Fax:707-643-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty