MEDICARE: SHELLY M GALVIN, DDS, PA

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	KS6671	KS

General Provider Information

NPI Number	:	1710100441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLY M GALVIN, DDS, PA

Provider Business Mailing Address
First Line	:	4527 RAINBOW BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66103-3428
Country	:	US
Telephone Number	:	913-432-0765
Fax Number	:	913-432-6022

Provider Business Practice Location Address
First Line	:	4527 RAINBOW BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66103-3428
Country	:	US
Telephone Number	:	913-432-0765
Fax Number	:	913-432-6022

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHELLY M GALVIN
Credential	:	DDS
Telephone Number	:	913-432-0765

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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