Provider Demographics
NPI:1346232642
Name:GALVAN, JESUS CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:CARLOS
Last Name:GALVAN
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 1:2500 LOUISIANA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4372
Mailing Address - Country:US
Mailing Address - Phone:505-855-7103
Mailing Address - Fax:505-883-7444
Practice Address - Street 1:2500 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE 600
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4343
Practice Address - Country:US
Practice Address - Phone:505-855-7103
Practice Address - Fax:505-883-7444
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD14631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice