Provider Demographics
NPI:1194333419
Name:GALAN, DIANNE GISELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:GISELLE
Last Name:GALAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:GISELLE
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1313 GUADALUPE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5554
Mailing Address - Country:US
Mailing Address - Phone:210-212-3900
Mailing Address - Fax:
Practice Address - Street 1:1313 GUADALUPE ST STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5554
Practice Address - Country:US
Practice Address - Phone:210-212-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice