Provider Demographics
NPI:1265754824
Name:RAWSON & BRAXTON ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF WEST FL
Entity type:Organization
Organization Name:RAWSON & BRAXTON ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF WEST FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZIEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-477-8482
Mailing Address - Street 1:1100 AIRPORT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8622
Mailing Address - Country:US
Mailing Address - Phone:850-477-8482
Mailing Address - Fax:850-477-7604
Practice Address - Street 1:1100 AIRPORT BLVD STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8622
Practice Address - Country:US
Practice Address - Phone:850-477-8482
Practice Address - Fax:850-477-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty