Provider Demographics
NPI:1427129907
Name:GALVIN, TY MITCHELL (DDS)
Entity type:Individual
Prefix:DR
First Name:TY
Middle Name:MITCHELL
Last Name:GALVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:425-277-2042
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:425-277-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000054231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice