Provider Demographics
NPI:1710100441
Name:SHELLY M GALVIN, DDS, PA
Entity Type:Organization
Organization Name:SHELLY M GALVIN, DDS, PA
Other - Org Name:WESTWOOD DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-432-0765
Mailing Address - Street 1:4527 RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-3428
Mailing Address - Country:US
Mailing Address - Phone:913-432-0765
Mailing Address - Fax:913-432-6022
Practice Address - Street 1:4527 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-3428
Practice Address - Country:US
Practice Address - Phone:913-432-0765
Practice Address - Fax:913-432-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS66711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty