Provider Demographics
NPI:1003136649
Name:MANSON, MARIAN ISKANDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:ISKANDER
Last Name:MANSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S RIVERSIDE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4321
Mailing Address - Country:US
Mailing Address - Phone:321-209-1703
Mailing Address - Fax:321-473-3565
Practice Address - Street 1:105 S RIVERSIDE DR STE 110
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4321
Practice Address - Country:US
Practice Address - Phone:321-209-1703
Practice Address - Fax:321-473-3565
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN191431223P0221X
CA64478122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist