Provider Demographics
NPI:1831307610
Name:TERESA M. AVENDANO-GALVEZ,DMD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:TERESA M. AVENDANO-GALVEZ,DMD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT- DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:AVENDANO-GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-323-0290
Mailing Address - Street 1:1451 W ARTESIA BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3232
Mailing Address - Country:US
Mailing Address - Phone:310-323-0290
Mailing Address - Fax:
Practice Address - Street 1:1451 W ARTESIA BLVD STE 6
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3232
Practice Address - Country:US
Practice Address - Phone:310-323-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37079-01OtherDENTI-CAL