Provider Demographics
NPI:1750504031
Name:GALVEZ, BERNARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:GALVEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6283 RIVERBANK CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2525
Mailing Address - Country:US
Mailing Address - Phone:209-477-3411
Mailing Address - Fax:
Practice Address - Street 1:123 S COMMERCE ST
Practice Address - Street 2:SUITE. C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2837
Practice Address - Country:US
Practice Address - Phone:209-465-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist