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General NPI Number Information
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NPI Number | 1811138662
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Entity Type | Organization
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Legal Business Name | MANATEE ORAL AND FACIAL SURGERY CENTER LLC
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Dates
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Enumeration Date | 03/07/2009
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 5460 LENA RD UNIT 102
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City | BRADENTON
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State | FL
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Zip | 34211-9500
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Country | US
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Telephone | 502-644-7833
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Fax | 941-492-7184
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Provider Business Mailing Address
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Address Line | 5460 LENA RD UNIT 102
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City | BRADENTON
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State | FL
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Zip | 34211-9500
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Country | US
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Telephone | 502-644-7833
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Fax | 941-492-7184
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Authorized Official
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Title or Position | OWNER
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Name | PRASHANT PANDYA
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Credential | DMD
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Telephone | 502-644-7833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN17268
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License Number State | FL
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