Provider Demographics
NPI:1790797546
Name:HALILI, MARINELA GALVIN (DMD)
Entity Type:Individual
Prefix:
First Name:MARINELA
Middle Name:GALVIN
Last Name:HALILI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:85035
Mailing Address - Country:US
Mailing Address - Phone:408-946-5999
Mailing Address - Fax:408-946-6463
Practice Address - Street 1:396 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:85035
Practice Address - Country:US
Practice Address - Phone:408-946-5999
Practice Address - Fax:408-946-6463
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice