Provider Demographics
NPI:1417016924
Name:GALEN, DOUGLAS MARC (DDS,)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MARC
Last Name:GALEN
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 1:8920 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 442
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2007
Mailing Address - Country:US
Mailing Address - Phone:310-855-1000
Mailing Address - Fax:
Practice Address - Street 1:8920 WILSHIRE BLVD
Practice Address - Street 2:SUITE 442
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2007
Practice Address - Country:US
Practice Address - Phone:310-855-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD392641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU60800Medicare UPIN