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General NPI Number Information
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NPI Number | 1396189825
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Entity Type | Individual
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Provider Name | GAURI DIPAK MANKAME D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2013
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 300 NW 70TH AVE STE 109
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City | PLANTATION
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State | FL
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Zip | 33317-2360
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Country | US
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Telephone | 954-791-1630
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Fax |
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Provider Business Mailing Address
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Address Line | 431 NW 108TH AVE
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City | PLANTATION
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State | FL
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Zip | 33324-1546
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Country | US
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Telephone | 954-683-8056
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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 | 19877
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License Number State | FL
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