Provider Demographics
NPI:1508371808
Name:BENJAMIN F MANCIA DDS PA
Entity Type:Organization
Organization Name:BENJAMIN F MANCIA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-559-5571
Mailing Address - Street 1:8370 WEST FLAGLER ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144
Mailing Address - Country:US
Mailing Address - Phone:305-559-5571
Mailing Address - Fax:305-559-1639
Practice Address - Street 1:8370 WEST FLAGLER ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:305-559-5571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-10862261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental