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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