MEDICARE: SHELLY M. GALVIN, DDS, 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	122300000X	Dentist	015644	MO

General Provider Information

NPI Number	:	1356623102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLY M. GALVIN, DDS, LLC

Provider Business Mailing Address
First Line	:	9241 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3392
Country	:	US
Telephone Number	:	816-436-2525
Fax Number	:	816-436-1306

Provider Business Practice Location Address
First Line	:	9241 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3392
Country	:	US
Telephone Number	:	816-436-2525
Fax Number	:	816-436-1306

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. SHELLY M. GALVIN
Credential	:	D.D.S.
Telephone Number	:	816-436-2525

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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