MEDICARE: BRADEN GALVIN

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	2901021528	MI

General Provider Information

NPI Number	:	1598146532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADEN GALVIN

Provider Business Mailing Address
First Line	:	1550 W SIDNEY RD
Second Line	:
City	:	SIDNEY
State	:	MI
Zip	:	48885-9748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 W SIDNEY RD
Second Line	:
City	:	SIDNEY
State	:	MI
Zip	:	48885
Country	:	US
Telephone Number	:	877-328-0777
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	10/02/2018

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Directions to “ BRADEN GALVIN ” Practice Location

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