Provider Demographics
NPI:1063863124
Name:MANNE & BORER ENDODONTICS AND MICROSURGERY PL
Entity Type:Organization
Organization Name:MANNE & BORER ENDODONTICS AND MICROSURGERY PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-676-0705
Mailing Address - Street 1:150 SAGEBRUSH TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8102
Mailing Address - Country:US
Mailing Address - Phone:386-676-0705
Mailing Address - Fax:
Practice Address - Street 1:150 SAGEBRUSH TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8102
Practice Address - Country:US
Practice Address - Phone:386-676-0705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty