Provider Demographics
NPI:1902070899
Name:MANATEE DENTAL PA
Entity Type:Organization
Organization Name:MANATEE DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-747-4000
Mailing Address - Street 1:3805 ST RD 64 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208
Mailing Address - Country:US
Mailing Address - Phone:941-747-4000
Mailing Address - Fax:941-714-0403
Practice Address - Street 1:3805 ST RD 64 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-747-4000
Practice Address - Fax:941-714-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty