Provider Demographics
NPI:1447072301
Name:GALAVIZ, DENISE (RDH,PHDH)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GALAVIZ
Suffix:
Gender:F
Credentials:RDH,PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-1584
Mailing Address - Country:US
Mailing Address - Phone:847-445-7943
Mailing Address - Fax:
Practice Address - Street 1:2323 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3312
Practice Address - Country:US
Practice Address - Phone:847-666-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020016185124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist