MEDICARE: ANDREW BENJAMIN MANCIA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN23921	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396407730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW BENJAMIN MANCIA DMD

Provider Business Mailing Address
First Line	:	600 TECHNOLOGY PARK STE 101
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-7122
Country	:	US
Telephone Number	:	407-543-8509
Fax Number	:

Provider Business Practice Location Address
First Line	:	14444 BEACH BLVD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-2010
Country	:	US
Telephone Number	:	904-223-4939
Fax Number	:	904-903-4551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	10/13/2021

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