Provider Demographics
NPI:1619122108
Name:MANASSE, DORONE MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DORONE
Middle Name:MARK
Last Name:MANASSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N FEDERAL HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2400
Mailing Address - Country:US
Mailing Address - Phone:954-925-5153
Mailing Address - Fax:954-454-6163
Practice Address - Street 1:1001 N FEDERAL HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2400
Practice Address - Country:US
Practice Address - Phone:954-925-5153
Practice Address - Fax:954-454-6163
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN127441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice