Provider Demographics
NPI:1508952482
Name:M. PATRICK ARDOIN II, DDS, PA
Entity Type:Organization
Organization Name:M. PATRICK ARDOIN II, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ARDOIN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-748-7983
Mailing Address - Street 1:3106 MANATEE AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-3351
Mailing Address - Country:US
Mailing Address - Phone:941-748-7983
Mailing Address - Fax:941-748-6074
Practice Address - Street 1:3106 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-3351
Practice Address - Country:US
Practice Address - Phone:941-748-7983
Practice Address - Fax:941-748-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10871261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental