Provider Demographics
NPI:1598146532
Name:GALVIN, BRADEN
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:GALVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 W SIDNEY RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48885-9748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 W SIDNEY RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MI
Practice Address - Zip Code:48885
Practice Address - Country:US
Practice Address - Phone:877-328-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010215281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice