Provider Demographics
NPI:1548585862
Name:DAVID GALATAS, DDS, PA
Entity Type:Organization
Organization Name:DAVID GALATAS, DDS, PA
Other - Org Name:FAYETTEVILLE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, BS
Authorized Official - Phone:910-484-5141
Mailing Address - Street 1:3416 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1610
Mailing Address - Country:US
Mailing Address - Phone:910-484-5141
Mailing Address - Fax:910-481-8913
Practice Address - Street 1:3416 MELROSE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1610
Practice Address - Country:US
Practice Address - Phone:910-484-5141
Practice Address - Fax:910-481-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901507Medicaid