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General NPI Number Information
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NPI Number | 1518788967
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Entity Type | Organization
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Legal Business Name | AVESIS OF FLORIDA, INC.
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 1200 S PINE ISLAND RD
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City | PLANTATION
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State | FL
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Zip | 33324-4413
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Country | US
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Telephone | 800-522-0258
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Fax |
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Provider Business Mailing Address
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Address Line | 1295 W WASHINGTON ST STE 212
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City | TEMPE
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State | AZ
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Zip | 85288-1234
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Country | US
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Telephone | 800-522-0258
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | DR. PAUL JASON MANN
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Credential | DMD
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Telephone | 602-603-6006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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