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General NPI Number Information
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NPI Number | 1154889988
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Entity Type | Individual
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Provider Name | CARLOS MANUEL ANICETO
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Gender | Male
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 5285 RED BUG LAKE RD STE 105
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-4973
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Country | US
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Telephone | 407-696-4474
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Fax | 407-696-1001
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Provider Business Mailing Address
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Address Line | 983 BENNETT RD APT 201
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City | ORLANDO
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State | FL
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Zip | 32814-6092
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Country | US
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Telephone | 786-662-9648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN26160
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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