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General NPI Number Information
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NPI Number | 1639484686
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Entity Type | Individual
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Provider Name | JOHANNA GALLEGO-ECKSTEIN
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Gender | Female
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Dates
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Enumeration Date | 08/15/2010
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 3031 NE 163RD ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-4462
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Country | US
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Telephone | 305-945-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 1914 NE 204TH TER
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City | MIAMI
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State | FL
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Zip | 33179-2250
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Country | US
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Telephone | 954-682-9303
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 20453
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20453
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License Number State | FL
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