Provider Demographics
NPI:1902259237
Name:TY M. GALVIN, D.D.S.
Entity Type:Organization
Organization Name:TY M. GALVIN, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-255-1661
Mailing Address - Street 1:130 S 3RD PL STE 2
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2439
Mailing Address - Country:US
Mailing Address - Phone:425-255-1661
Mailing Address - Fax:
Practice Address - Street 1:130 S 3RD PL STE 2
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2439
Practice Address - Country:US
Practice Address - Phone:425-255-1661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005423261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental