Healthcare Provider Details

I. General information

NPI: 1700944311
Provider Name (Legal Business Name): EDWARD MATTHEW GALIDA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 MILL RD
BELLVILLE OH
44813-1280
US

IV. Provider business mailing address

741 MILL RD
BELLVILLE OH
44813-1280
US

V. Phone/Fax

Practice location:
  • Phone: 419-886-0200
  • Fax: 410-886-4495
Mailing address:
  • Phone: 419-886-0200
  • Fax: 410-886-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30021423
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: