Healthcare Provider Details

I. General information

NPI: 1366671927
Provider Name (Legal Business Name): MANIK SINGH BEDI M.D., D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2009
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17751 GUNN HWY
ODESSA FL
33556
US

IV. Provider business mailing address

17751 GUNN HWY
ODESSA FL
33556-1912
US

V. Phone/Fax

Practice location:
  • Phone: 813-836-7202
  • Fax:
Mailing address:
  • Phone: 813-836-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN18708
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME1239093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: