Provider Demographics
NPI:1396189825
Name:MANKAME, GAURI DIPAK (DMD)
Entity type:Individual
Prefix:
First Name:GAURI
Middle Name:DIPAK
Last Name:MANKAME
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 NW 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1546
Mailing Address - Country:US
Mailing Address - Phone:954-683-8056
Mailing Address - Fax:
Practice Address - Street 1:300 NW 70TH AVE STE 109
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2360
Practice Address - Country:US
Practice Address - Phone:954-791-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist