Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN24848 | FL |
NPI | 1265055628 |
---|---|
Provider Name | Dr. Nima Iranmanesh |
First Address | Tampa, FL 33618-8609 |
Second Address | Tampa, FL 33614-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2020 |
Last Update Date | 20/05/2020 |