NPI: 1407279177
Provider Name: GALLERIA ORAL AND MAXILLOFACIAL SURGERY
Former Legal Business Name: ALEXANDER O. ANTIPOV, D.D.S., INC
Classification: Dentist - 1223S0112X
Entity Type: Organization
Specialization: Oral and Maxillofacial Surgery
Address:
911 RESERVE DRIVE
SUITE #150
ROSEVILLE, CA
ZIP 95678
Phone: (916) 783-2110
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GALLERIA ORAL AND MAXILLOFACIAL SURGERY is an oral and maxillofacial surgery dentist in Roseville, CA. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. GALLERIA ORAL AND MAXILLOFACIAL SURGERY NPI is 1407279177. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Alexander O. Antipov, D.d.s., Inc.
The provider's business location address is:
911 RESERVE DRIVE
SUITE #150
ROSEVILLE, CA
ZIP 95678
Phone: (916) 783-2110
Fax: (916) 783-2111
The provider's authorized official is Yelena Myalik .
The authorized official title is Office Manager and has the following contact phone number (916) 783-2110.
The enumeration date for this NPI number is 1/30/2014 and was last updated on 1/30/2014.