Provider Demographics
NPI:1689726465
Name:GALANIS, STACEY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:B
Last Name:GALANIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:GALANIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8201 MENARD AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3334
Mailing Address - Country:US
Mailing Address - Phone:847-967-5286
Mailing Address - Fax:
Practice Address - Street 1:1029 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3877
Practice Address - Country:US
Practice Address - Phone:847-491-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist