Provider Demographics
NPI:1104252139
Name:SEAGE, MANUEL R (DDS)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:R
Last Name:SEAGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 BILTMORE WAY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5755
Mailing Address - Country:US
Mailing Address - Phone:305-445-6969
Mailing Address - Fax:
Practice Address - Street 1:475 BILTMORE WAY
Practice Address - Street 2:SUITE 302
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5755
Practice Address - Country:US
Practice Address - Phone:305-445-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist