Healthcare Provider Details

I. General information

NPI: 1316011646
Provider Name (Legal Business Name): WILLIAM GUO GALANOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WEST 81ST AVE STE H
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

500 WEST 81ST AVE STE H
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-1212
  • Fax: 219-736-2612
Mailing address:
  • Phone: 219-736-1212
  • Fax: 219-736-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12008902
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: