Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5442 | FL |
NPI | 1013027093 |
---|---|
Provider Name | Dr. Alfred Wesley Mann III |
First Address | Port Richey, FL 34668-6839 |
Second Address | Port Richey, FL 34668-6839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |