Provider Demographics
NPI:1851310999
Name:JUAN JOSE GALVAN DDS INC
Entity Type:Organization
Organization Name:JUAN JOSE GALVAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-266-7200
Mailing Address - Street 1:8440 WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4123
Mailing Address - Country:US
Mailing Address - Phone:440-266-7200
Mailing Address - Fax:440-266-0225
Practice Address - Street 1:8440 WESTPORT DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4123
Practice Address - Country:US
Practice Address - Phone:440-266-7200
Practice Address - Fax:440-266-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty