Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN9380 | FL |
NPI | 1467669606 |
---|---|
Provider Name | Ashok Manocha |
First Address | Tallahassee, FL 32308-5250 |
Second Address | Tallahassee, FL 32308-5250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 24/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
072656700 | (05) | FL |