Healthcare Provider Details

I. General information

NPI: 1134559636
Provider Name (Legal Business Name): MICHAEL RYAN GALADA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 TOWN CENTER PKWY
SANTEE CA
92071-5803
US

IV. Provider business mailing address

9237 REGENTS RD APT 120
LA JOLLA CA
92037-9184
US

V. Phone/Fax

Practice location:
  • Phone: 619-312-6006
  • Fax:
Mailing address:
  • Phone: 347-893-1862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number29581
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29581
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number65240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: