Provider Demographics
NPI:1346663473
Name:ALEXANDER A. GALVAN, DMD APC
Entity Type:Organization
Organization Name:ALEXANDER A. GALVAN, DMD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-873-3000
Mailing Address - Street 1:1244 W BASE LINE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8640
Mailing Address - Country:US
Mailing Address - Phone:909-873-3000
Mailing Address - Fax:909-873-3008
Practice Address - Street 1:1244 W BASE LINE RD
Practice Address - Street 2:SUITE E
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8640
Practice Address - Country:US
Practice Address - Phone:909-873-3000
Practice Address - Fax:909-873-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45861261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental