Provider Demographics
NPI:1356559827
Name:GALVAN, ROMARICO N (DMD)
Entity type:Individual
Prefix:DR
First Name:ROMARICO
Middle Name:N
Last Name:GALVAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 PHILADELPHIA ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2240
Mailing Address - Country:US
Mailing Address - Phone:909-465-1010
Mailing Address - Fax:
Practice Address - Street 1:633 S SAN GABRIEL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2754
Practice Address - Country:US
Practice Address - Phone:626-286-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice