Healthcare Provider Details

I. General information

NPI: 1194946798
Provider Name (Legal Business Name): RAMON GALVAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE UTHSC DENTAL SCHOOL
MEMPHIS TN
38103
US

IV. Provider business mailing address

875 UNION AVE
MEMPHIS TN
38103-3513
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6387
  • Fax:
Mailing address:
  • Phone: 901-448-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10747
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberNJDIO18946
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number10747
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: