# GALLERIA ORAL AND MAXILLOFACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Alexander O. Antipov, D.D.S., Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407279177
- **Authorized official:** YELENA MYALIK (OFFICE MANAGER)
- **Authorized official phone:** (916) 783-2110

## Contact information

- **Practice address:** 911 RESERVE DRIVE, SUITE \#150, ROSEVILLE, CA 95678
- **Practice address phone:** (916) 783-2110
- **Practice address fax:** (916) 783-2111
- **Mailing address:** 911 RESERVE DRIVE, SUITE \#150, ROSEVILLE, CA 95678
- **Mailing address phone:** (916) 783-2110
- **Mailing address fax:** (916) 783-2111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | CA | Yes |

## Other

- **Enumeration date:** 01/30/2014
- **Last updated:** 01/30/2014