Provider Demographics
NPI:1548387806
Name:CARDENAS-MANSUR, ANGELICA (DMD,PA)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:CARDENAS-MANSUR
Suffix:
Gender:F
Credentials:DMD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 NE 41ST TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6619
Mailing Address - Country:US
Mailing Address - Phone:305-245-3366
Mailing Address - Fax:305-246-5200
Practice Address - Street 1:3030 NE 41ST TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6619
Practice Address - Country:US
Practice Address - Phone:305-245-3366
Practice Address - Fax:305-246-5200
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist