Provider Demographics
NPI:1962710012
Name:MANATEE DENTAL OF SARASOTA
Entity type:Organization
Organization Name:MANATEE DENTAL OF SARASOTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-567-7437
Mailing Address - Street 1:2947 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7113
Mailing Address - Country:US
Mailing Address - Phone:941-921-7227
Mailing Address - Fax:941-923-4306
Practice Address - Street 1:2947 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7113
Practice Address - Country:US
Practice Address - Phone:941-921-7227
Practice Address - Fax:941-923-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13483305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization