MEDICARE: DEMETRIOS E GALANIS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN02788	RI

General Provider Information

NPI Number	:	1265506646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRIOS E GALANIS DMD

Provider Business Mailing Address
First Line	:	12 MAIN STREET
Second Line	:
City	:	BLACKSTONE
State	:	MA
Zip	:	01504
Country	:	US
Telephone Number	:	508-883-1050
Fax Number	:	508-883-0911

Provider Business Practice Location Address
First Line	:	12 MAIN STREET
Second Line	:
City	:	BLACKSTONE
State	:	MA
Zip	:	01504
Country	:	US
Telephone Number	:	508-883-1050
Fax Number	:	508-883-0911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	01/30/2008

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Directions to “ DEMETRIOS E GALANIS DMD” Practice Location

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