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General NPI Number Information
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NPI Number | 1518887173
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Entity Type | Organization
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Legal Business Name | BCG DENTAL GROUP, P LLC
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 481 N HARBOR CITY BLVD STE 102
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City | MELBOURNE
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State | FL
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Zip | 32935-6877
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Country | US
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Telephone | 321-254-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 481 N HARBOR CITY BLVD STE 102
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City | MELBOURNE
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State | FL
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Zip | 32935-6877
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Country | US
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Telephone | 321-254-7474
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST OWNER
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Name | DR. MARIAN ISKANDER MANSON
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Credential | DMD MDS
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Telephone | 321-254-7474
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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 |
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License Number State |
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