Healthcare Provider Details

I. General information

NPI: 1306242482
Provider Name (Legal Business Name): MENGELBERG DENTAL ARTS. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 BEE RIDGE RD SUITE 101
SARASOTA FL
34233-1502
US

IV. Provider business mailing address

5500 BEE RIDGE RD SUITE 101
SARASOTA FL
34233-1502
US

V. Phone/Fax

Practice location:
  • Phone: 941-371-2022
  • Fax:
Mailing address:
  • Phone: 941-371-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberDN12930
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN ERNEST MENGELBERG
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 941-320-7952