Healthcare Provider Details

I. General information

NPI: 1790051043
Provider Name (Legal Business Name): DENNIS GALVIN LAC, DAOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6458 LOWER YORK RD
NEW HOPE PA
18938-5696
US

IV. Provider business mailing address

6458 LOWER YORK RD
NEW HOPE PA
18938-5696
US

V. Phone/Fax

Practice location:
  • Phone: 267-714-4149
  • Fax: 267-202-7472
Mailing address:
  • Phone: 267-714-4149
  • Fax: 267-202-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberOM000144
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: