Provider Demographics
NPI:1114062726
Name:GALBRAITH, TED R (DDS)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:R
Last Name:GALBRAITH
Suffix:
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 1:500 RAY C HUNT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2981
Mailing Address - Country:US
Mailing Address - Phone:434-980-6140
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:1222 JEFFERSON PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-3410
Practice Address - Country:US
Practice Address - Phone:434-924-1774
Practice Address - Fax:434-982-6417
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007823576Medicaid
VAT83888Medicare UPIN
VA190000209Medicare ID - Type Unspecified