Provider Demographics
NPI:1780040618
Name:EASTSIDE DENTAL LLC
Entity Type:Organization
Organization Name:EASTSIDE DENTAL LLC
Other - Org Name:DR. FRANK R. GALKA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GALKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-276-4455
Mailing Address - Street 1:1845 N FARWELL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1793
Mailing Address - Country:US
Mailing Address - Phone:414-276-4455
Mailing Address - Fax:414-276-6898
Practice Address - Street 1:1845 N FARWELL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1793
Practice Address - Country:US
Practice Address - Phone:414-276-4455
Practice Address - Fax:414-276-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental