Provider Demographics
NPI:1821427675
Name:MANKAME, DIPAK M., D.D.S., P.A.
Entity Type:Organization
Organization Name:MANKAME, DIPAK M., D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:MEGHNATH
Authorized Official - Last Name:MANKAME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-791-1630
Mailing Address - Street 1:300 N.W. 70TH AVE SUITE 109
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-791-1630
Mailing Address - Fax:954-916-7781
Practice Address - Street 1:300 N.W. 70TH AVE SUITE 109
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-791-1630
Practice Address - Fax:954-916-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty