Provider Demographics
NPI:1942336482
Name:FERNANDO A. GALEANO D.D.S.,P.A.
Entity Type:Organization
Organization Name:FERNANDO A. GALEANO D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:GALEANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-985-2826
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:813-985-2826
Mailing Address - Fax:
Practice Address - Street 1:5208 E FOWLER AVE STE D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2152
Practice Address - Country:US
Practice Address - Phone:813-985-2826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN130661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty