Healthcare Provider Details

I. General information

NPI: 1851477889
Provider Name (Legal Business Name): WILLIAM RALPH GAROFALO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 LIBERTY ST.
PERRYOPOLIS PA
15473
US

IV. Provider business mailing address

399 LIBERTY ST.
PERRYOPOLIS PA
15473-0636
US

V. Phone/Fax

Practice location:
  • Phone: 724-736-2550
  • Fax: 724-785-2184
Mailing address:
  • Phone: 724-736-2550
  • Fax: 724-785-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS-024140-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: