Healthcare Provider Details

I. General information

NPI: 1942336482
Provider Name (Legal Business Name): FERNANDO A. GALEANO D.D.S.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 E FOWLER AVE STE D
TAMPA FL
33617-2152
US

IV. Provider business mailing address

5222 E FOWLER AVE
TEMPLE TERRACE FL
33617-2147
US

V. Phone/Fax

Practice location:
  • Phone: 813-985-2826
  • Fax:
Mailing address:
  • Phone: 813-985-2826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN13066
License Number StateFL

VIII. Authorized Official

Name: DR. FERNANDO ALFREDO GALEANO
Title or Position: DIRECT OWNER
Credential: D.D.S.
Phone: 813-985-2826