Provider Demographics
NPI:1205910023
Name:ARDIN B. MANALO DMD PA
Entity type:Organization
Organization Name:ARDIN B. MANALO DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARDIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-935-0027
Mailing Address - Street 1:312 WEST BASS STREET
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-935-0027
Mailing Address - Fax:407-935-9322
Practice Address - Street 1:312 WEST BASS STREET
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-935-0027
Practice Address - Fax:407-935-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN129211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty