Healthcare Provider Details

I. General information

NPI: 1043979826
Provider Name (Legal Business Name): SUSAN DIANE GALVIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 S UNIVERSITY DRIVE DEPARTMENT OF ORAL SCIENCE AND TRANSLATIONAL RESEARCH
FORT LAUDERDALE FL
33328-2018
US

IV. Provider business mailing address

3300 S UNIVERSITY DRIVE DEPARTMENT OF ORAL SCIENCE AND TRANSLATIONAL RESEARCH
FORT LAUDERDALE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7315
  • Fax: 954-262-1782
Mailing address:
  • Phone: 954-262-7315
  • Fax: 954-262-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDTP826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: