Provider Demographics
NPI:1801012653
Name:GALAVIZ, RAFAEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:C
Last Name:GALAVIZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 SUNNYDELL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5003
Mailing Address - Country:US
Mailing Address - Phone:210-679-6414
Mailing Address - Fax:
Practice Address - Street 1:3315 SW MILITARY DR
Practice Address - Street 2:104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3660
Practice Address - Country:US
Practice Address - Phone:210-924-4593
Practice Address - Fax:210-924-4597
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0110141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice