MEDICARE: DR. JON P. GALEA D.D.S.

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	1223P0221X	Pediatric Dentistry	4182	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	826768	OTHER	NV	UNITED CONCORDIA

General Provider Information

NPI Number	:	1336115245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON P. GALEA D.D.S.

Provider Business Mailing Address
First Line	:	4472 PROSPECT HILL COURT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129
Country	:	US
Telephone Number	:	702-645-9149
Fax Number	:

Provider Business Practice Location Address
First Line	:	8981 W SAHARA AVE
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5897
Country	:	US
Telephone Number	:	702-254-4220
Fax Number	:

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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