Provider Demographics
NPI:1811537772
Name:GALYA RAZ, DMD, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:GALYA RAZ, DMD, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-775-4366
Mailing Address - Street 1:5146 MAYNARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-3946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15708 POMERADO RD # N104
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2066
Practice Address - Country:US
Practice Address - Phone:858-485-1108
Practice Address - Fax:858-485-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty