Provider Demographics
NPI:1265506646
Name:GALANIS, DEMETRIOS E (DMD)
Entity Type:Individual
Prefix:
First Name:DEMETRIOS
Middle Name:E
Last Name:GALANIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:MA
Mailing Address - Zip Code:01504
Mailing Address - Country:US
Mailing Address - Phone:508-883-1050
Mailing Address - Fax:508-883-0911
Practice Address - Street 1:12 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:MA
Practice Address - Zip Code:01504
Practice Address - Country:US
Practice Address - Phone:508-883-1050
Practice Address - Fax:508-883-0911
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN027881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice