Provider Demographics
NPI:1043979826
Name:GALVIS, SUSAN DIANE (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANE
Last Name:GALVIS
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:3300 S UNIVERSITY DRIVE
Mailing Address - Street 2:DEPARTMENT OF ORAL SCIENCE AND TRANSLATIONAL RESEARCH
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-7315
Mailing Address - Fax:954-262-1782
Practice Address - Street 1:3300 S UNIVERSITY DRIVE
Practice Address - Street 2:DEPARTMENT OF ORAL SCIENCE AND TRANSLATIONAL RESEARCH
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-7315
Practice Address - Fax:954-262-1782
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2024-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLDTP826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist