Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 014079 | MO |
NPI | 1104897628 |
---|---|
Provider Name | Dr. David Allen Galvan |
First Address | Rolla, MO 65401-4416 |
Second Address | Rolla, MO 65401-4416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 08/07/2007 |