MEDICARE: GALVAN DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	47894	CA

General Provider Information

NPI Number	:	1174765911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALVAN DENTAL LLC

Provider Business Mailing Address
First Line	:	2809 REDWOOD PKWY
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-3634
Country	:	US
Telephone Number	:	707-643-2273
Fax Number	:	707-643-4210

Provider Business Practice Location Address
First Line	:	2809 REDWOOD PKWY
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-3634
Country	:	US
Telephone Number	:	707-643-2273
Fax Number	:	707-643-4210

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FELIPE HALILI GALVAN JR.
Credential	:	DDS
Telephone Number	:	707-643-2273

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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