Healthcare Provider Details

I. General information

NPI: 1639484686
Provider Name (Legal Business Name): JOHANNA GALLEGO-ECKSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2010
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 NE 163RD ST
NORTH MIAMI BEACH FL
33160-4462
US

IV. Provider business mailing address

1914 NE 204TH TER
MIAMI FL
33179-2250
US

V. Phone/Fax

Practice location:
  • Phone: 305-945-0909
  • Fax:
Mailing address:
  • Phone: 954-682-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number20453
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: