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General NPI Number Information
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NPI Number | 1811537772
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Entity Type | Organization
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Legal Business Name | GALYA RAZ, DMD, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 15708 POMERADO RD # N104
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City | POWAY
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State | CA
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Zip | 92064-2066
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Country | US
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Telephone | 858-485-1108
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Fax | 858-485-1426
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Provider Business Mailing Address
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Address Line | 5146 MAYNARD ST
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City | SAN DIEGO
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State | CA
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Zip | 92122-3946
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DR. GALYA RAZ
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Credential | DMD
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Telephone | 858-775-4366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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