Provider Demographics
NPI:1831149517
Name:SERRA-JOVENICH, MANUEL (DDS)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:SERRA-JOVENICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:SERRA JOVENICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7171 CORAL WAY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:305-264-9191
Mailing Address - Fax:305-264-6246
Practice Address - Street 1:7171 CORAL WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-264-9191
Practice Address - Fax:305-264-6246
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist