Carlos Manuel Aniceto
Individual provider Active NPI Dentist · Winter Springs, FL
NPI 1154889988 · NPPES record last updated Nov 12, 2021
Key facts
- NPI
- 1154889988
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN26160 (FL)
- Practice address
- 5285 Red Bug Lake Rd Ste 105
Winter Springs, FL 32708-4973 - Phone
- (407) 696-4474
- Fax
- (407) 696-1001
- NPI assigned
- Mar 11, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210730001868 | FL | Order and Referring Only - Dentist |
8527461375 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coast Dental P.a. | Dentist | Current |
Accepting new patients |
| Aniceto Dental PA | Current | Accepting new patients | |
| Coast Dental P.a. | Dentist | Past |
Accepting new patients |
Locations
5285 Red Bug Lake Rd
Ste 105
Winter Springs, FL 32708
Phone (407) 696-4474
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN26160 | FL | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
5285 Red Bug Lake Rd Ste 105
Winter Springs, FL 32708-4973
Mailing address
983 Bennett Rd Apt 201
Orlando, FL 32814-6092
Phone (786) 662-9648
Other providers in Winter Springs, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.