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General NPI Number Information
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NPI Number | 1700330099
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Entity Type | Organization
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Legal Business Name | MANNE & BORER ENDODONTICS AND MICROSURGERY PL
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 7 BOULDER ROCK DR SUITE 1
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City | PALM COAST
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State | FL
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Zip | 32137-8546
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Country | US
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Telephone | 386-446-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 150 SAGEBRUSH TRL SUITE 1
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8102
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Country | US
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Telephone | 386-676-0705
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. ROBERT BORER
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Credential |
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Telephone | 386-446-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN15628
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License Number State | FL
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