Healthcare Provider Details

I. General information

NPI: 1518887173
Provider Name (Legal Business Name): BCG DENTAL GROUP, P LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 N HARBOR CITY BLVD STE 102
MELBOURNE FL
32935-6877
US

IV. Provider business mailing address

481 N HARBOR CITY BLVD STE 102
MELBOURNE FL
32935-6877
US

V. Phone/Fax

Practice location:
  • Phone: 321-254-7474
  • Fax:
Mailing address:
  • Phone: 321-254-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIAN ISKANDER MANSON
Title or Position: PEDIATRIC DENTIST OWNER
Credential: DMD MDS
Phone: 321-254-7474