MEDICARE: MARTIN GALSTUAN DENTAL CORPORATION

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	:	1518319334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN GALSTUAN DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 FAIR OAKS AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-2605
Country	:	US
Telephone Number	:	626-593-0053
Fax Number	:	626-486-9959

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. MARTIN A GALSTYAN
Credential	:	DDS
Telephone Number	:	626-593-0053

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	07/05/2016

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