Provider Demographics
NPI:1700959913
Name:ARDIN MANALO DMD PA
Entity Type:Organization
Organization Name:ARDIN MANALO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-246-0104
Mailing Address - Street 1:5301 CONROY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-3551
Mailing Address - Country:US
Mailing Address - Phone:407-246-0104
Mailing Address - Fax:407-246-1283
Practice Address - Street 1:5301 CONROY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3551
Practice Address - Country:US
Practice Address - Phone:407-246-0104
Practice Address - Fax:407-246-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN129211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty