Healthcare Provider Details

I. General information

NPI: 1588685341
Provider Name (Legal Business Name): DAVID A GALBRAITH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 FARMINGTON AVE
FARMINGTON CT
06032-1925
US

IV. Provider business mailing address

291 FARMINGTON AVE
FARMINGTON CT
06032-1925
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-7528
  • Fax: 860-678-7933
Mailing address:
  • Phone: 860-679-7528
  • Fax: 860-678-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5519
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: