Provider Demographics
NPI:1912929142
Name:GALVAN, JUAN J (DDS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:GALVAN
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 1:8440 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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185041223G0001X
FLDN 118131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice