Healthcare Provider Details

I. General information

NPI: 1003136649
Provider Name (Legal Business Name): MARIAN ISKANDER MANSON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
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 Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN19143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: