MEDICARE: WILLIAM E GALBRETH, DMD,PC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1508491747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM E GALBRETH, DMD,PC

Provider Business Mailing Address
First Line	:	4830 JUAN TABO BLVD NE STE H
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2682
Country	:	US
Telephone Number	:	505-298-8103
Fax Number	:	505-298-2363

Provider Business Practice Location Address
First Line	:	4830 JUAN TABO BLVD NE STE H
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2682
Country	:	US
Telephone Number	:	505-298-8103
Fax Number	:	505-298-2363

Authorized Official
Title or Position	:	OWNER
Name	:	WILLAIM EDWAR GALBRETH
Credential	:	DMD
Telephone Number	:	505-298-8103

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	03/09/2020

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