Provider Demographics
NPI:1316149164
Name:ANGELICA CARDENAS MANSUR, D.M.D., P.A.
Entity type:Organization
Organization Name:ANGELICA CARDENAS MANSUR, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISIT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENAS-MANSUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,PA
Authorized Official - Phone:305-245-3366
Mailing Address - Street 1:3030 NE 41ST TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6619
Mailing Address - Country:US
Mailing Address - Phone:305-245-3366
Mailing Address - Fax:305-246-5200
Practice Address - Street 1:3030 NE 41ST TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6619
Practice Address - Country:US
Practice Address - Phone:305-245-3366
Practice Address - Fax:305-246-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0016290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty