Provider Demographics
NPI:1669834172
Name:GALEANO, FERNANDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:GALEANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 E FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2147
Mailing Address - Country:US
Mailing Address - Phone:813-855-8505
Mailing Address - Fax:813-855-7307
Practice Address - Street 1:5222 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617
Practice Address - Country:US
Practice Address - Phone:813-855-8505
Practice Address - Fax:813-855-7307
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13066122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1942336482OtherFACILITY NPI