Provider Demographics
NPI:1518708072
Name:FLEURINORD, MANOUCHKA (DDS)
Entity type:Individual
Prefix:
First Name:MANOUCHKA
Middle Name:
Last Name:FLEURINORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MORSE ST NE APT 724
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7495
Mailing Address - Country:US
Mailing Address - Phone:786-509-3882
Mailing Address - Fax:
Practice Address - Street 1:665 SCRANTON RD STE 4
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1975
Practice Address - Country:US
Practice Address - Phone:912-694-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist