Provider Demographics
NPI:1508474412
Name:GALOVICH, BRANDON (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:GALOVICH
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 1:209 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-3307
Mailing Address - Country:US
Mailing Address - Phone:307-347-2544
Mailing Address - Fax:307-347-2352
Practice Address - Street 1:209 S 7TH ST
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3307
Practice Address - Country:US
Practice Address - Phone:307-347-2544
Practice Address - Fax:307-347-2352
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist