Provider Demographics
NPI:1518788967
Name:AVESIS OF FLORIDA, INC.
Entity type:Organization
Organization Name:AVESIS OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-603-6006
Mailing Address - Street 1:1295 W WASHINGTON ST STE 212
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-1234
Mailing Address - Country:US
Mailing Address - Phone:800-522-0258
Mailing Address - Fax:
Practice Address - Street 1:1200 S PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4413
Practice Address - Country:US
Practice Address - Phone:800-522-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVATAR HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization