Healthcare Provider Details

I. General information

NPI: 1336115245
Provider Name (Legal Business Name): JON P. GALEA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8981 W SAHARA AVE SUITE 110
LAS VEGAS NV
89117-5897
US

IV. Provider business mailing address

4472 PROSPECT HILL COURT
LAS VEGAS NV
89129
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-4220
  • Fax:
Mailing address:
  • Phone: 702-645-9149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4182
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: