MEDICARE: GALVA FAMILY DENTISTRY, INC.

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	019030515	IL

General Provider Information

NPI Number	:	1518330505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALVA FAMILY DENTISTRY, INC.

Provider Business Mailing Address
First Line	:	308 11TH ST
Second Line	:
City	:	PORT BYRON
State	:	IL
Zip	:	61275-9038
Country	:	US
Telephone Number	:	309-523-3325
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 11TH ST
Second Line	:
City	:	PORT BYRON
State	:	IL
Zip	:	61275-9038
Country	:	US
Telephone Number	:	309-523-3325
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT BIALOBRESKI
Credential	:	D.D.S.
Telephone Number	:	309-932-2000

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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