Provider Demographics
NPI:1689954265
Name:GERMANOVYCH, GALYNA (REGISTERED DENTAL HY)
Entity Type:Individual
Prefix:
First Name:GALYNA
Middle Name:
Last Name:GERMANOVYCH
Suffix:
Gender:F
Credentials:REGISTERED DENTAL HY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 UCONN AVE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1365
Mailing Address - Country:US
Mailing Address - Phone:860-528-1359
Mailing Address - Fax:860-528-2353
Practice Address - Street 1:63 UCONN AVE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1365
Practice Address - Country:US
Practice Address - Phone:860-528-1359
Practice Address - Fax:860-528-2353
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007696124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
007696OtherFOR SOLE REGISTERED DENTAL HYGIENIST