Provider Demographics
NPI:1770672537
Name:GALVIS, DIANA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:GALVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 TOTOWA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512
Mailing Address - Country:US
Mailing Address - Phone:973-720-0634
Mailing Address - Fax:973-720-9527
Practice Address - Street 1:142 TOTOWA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512
Practice Address - Country:US
Practice Address - Phone:973-720-0621
Practice Address - Fax:973-720-9527
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021895001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice