Healthcare Provider Details

I. General information

NPI: 1346663473
Provider Name (Legal Business Name): ALEXANDER A. GALVAN, DMD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 W BASE LINE RD SUITE E
RIALTO CA
92376-8640
US

IV. Provider business mailing address

1244 W BASE LINE RD SUITE E
RIALTO CA
92376-8640
US

V. Phone/Fax

Practice location:
  • Phone: 909-873-3000
  • Fax: 909-873-3008
Mailing address:
  • Phone: 909-873-3000
  • Fax: 909-873-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number45861
License Number StateCA

VIII. Authorized Official

Name: DR. ALEXANDER GALVAN
Title or Position: DMD
Credential:
Phone: 909-873-3000