Provider Demographics
NPI:1033756465
Name:TERESA AVENDANO-GALVEZ DMD INC
Entity Type:Organization
Organization Name:TERESA AVENDANO-GALVEZ DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:AVENDANO-GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-753-9273
Mailing Address - Street 1:1414 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-3119
Mailing Address - Country:US
Mailing Address - Phone:562-595-8553
Mailing Address - Fax:562-595-9123
Practice Address - Street 1:1414 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-3119
Practice Address - Country:US
Practice Address - Phone:562-595-8553
Practice Address - Fax:562-595-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental