Provider Demographics
NPI:1093835340
Name:GALICH, JOHN WILLIAM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:GALICH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 STAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-3286
Mailing Address - Country:US
Mailing Address - Phone:704-289-4505
Mailing Address - Fax:704-283-8654
Practice Address - Street 1:1276 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3286
Practice Address - Country:US
Practice Address - Phone:704-289-4505
Practice Address - Fax:704-283-8654
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice