MEDICARE: ROMARICO N. GALVAN DMD 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	33140	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548417462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROMARICO N. GALVAN DMD INC

Provider Business Mailing Address
First Line	:	4514 PHILADELPHIA ST
Second Line	:	SUITE A
City	:	CHINO
State	:	CA
Zip	:	91710-2240
Country	:	US
Telephone Number	:	909-465-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	4514 PHILADELPHIA ST
Second Line	:	SUITE A
City	:	CHINO
State	:	CA
Zip	:	91710-2240
Country	:	US
Telephone Number	:	909-465-1016
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROMARICO N GALVAN
Credential	:	DMD
Telephone Number	:	909-465-1016

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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