MEDICARE: DR. SUSAN DIANE GALVIS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DTP826	FL

General Provider Information

NPI Number	:	1043979826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN DIANE GALVIS DDS

Provider Business Mailing Address
First Line	:	3300 S UNIVERSITY DRIVE
Second Line	:	DEPARTMENT OF ORAL SCIENCE AND TRANSLATIONAL RESEARCH
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33328-2018
Country	:	US
Telephone Number	:	954-262-7315
Fax Number	:	954-262-1782

Provider Business Practice Location Address
First Line	:	3300 S UNIVERSITY DRIVE
Second Line	:	DEPARTMENT OF ORAL SCIENCE AND TRANSLATIONAL RESEARCH
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33328-2018
Country	:	US
Telephone Number	:	954-262-7315
Fax Number	:	954-262-1782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	09/17/2024

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