Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 1301 | FL |
NPI | 1093121857 |
---|---|
Provider Name | Sidni Manne |
First Address | Gainesville, FL 32608-1016 |
Second Address | Gainesville, FL 32608-1016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 01/07/2014 |