Individual
DR. IAN THOMAS MANFREDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5696 TUSCOLA BLVD, NORTH PORT, FL 34287-2738
(941) 257-0726
Mailing address
5696 TUSCOLA BLVD, NORTH PORT, FL 34287-2738
(941) 257-0726
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN28617
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
04/24/2023
Last updated
09/20/2023
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