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General NPI Number Information
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NPI Number | 1760689640
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Entity Type | Organization
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Legal Business Name | GALVEZ DENTAL CORPORATION
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 123 S COMMERCE ST STE. C
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City | STOCKTON
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State | CA
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Zip | 95202-2837
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Country | US
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Telephone | 209-465-5823
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Fax |
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Provider Business Mailing Address
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Address Line | 123 S COMMERCE ST STE. C
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City | STOCKTON
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State | CA
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Zip | 95202-2837
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Country | US
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Telephone | 209-465-5823
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CORAZON ABELLERA GALVEZ
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Credential | D.M.D.
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Telephone | 209-465-5823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25322
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License Number State | CA
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