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Organization

MANATEE ORAL AND FACIAL SURGERY CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PRASHANT PANDYA DMD (OWNER)
(502) 644-7833
Entity
Organization

Contact information

Practice address
5460 LENA RD, UNIT 102, BRADENTON, FL 34211-9500
(502) 644-7833
(941) 492-7184
Mailing address
5460 LENA RD, UNIT 102, BRADENTON, FL 34211-9500
(502) 644-7833
(941) 492-7184

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN17268
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DN17268
MEDICAL LICENSE
FL
Enumeration date
03/07/2009
Last updated
03/09/2009
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