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General NPI Number Information
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NPI Number | 1902070899
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Entity Type | Organization
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Legal Business Name | MANATEE DENTAL PA
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 3805 ST RD 64 E
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City | BRADENTON
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State | FL
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Zip | 34208
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Country | US
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Telephone | 941-747-4000
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Fax | 941-714-0403
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Provider Business Mailing Address
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Address Line | 3805 ST RD 64 E
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City | BRADENTON
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State | FL
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Zip | 34208
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Country | US
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Telephone | 941-747-4000
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Fax | 941-714-0403
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. DENNIS ANTHONY CORONA
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Credential | DDS
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Telephone | 941-747-4000
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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 | DN13483
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License Number State | FL
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