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Organization
PERIO DOCTOR LLC
Active
Organization
PERIO DOCTOR LLC
Active
Other names
OASIS PERIO
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VANESSA LYNN MANCUSO DDS,MSD (OWNER)
(786) 449-4262
Entity
Organization
Contact information
Practice address
1312 E BROWARD BLVD, FORT LAUDERDALE, FL 33301-2136
(786) 449-4262
Mailing address
1312 E BROWARD BLVD, FORT LAUDERDALE, FL 33301-2136
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
04/26/2024
Last updated
04/26/2024
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