Ian Thomas Manfredo, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN28617 Issued in FL

Practice address

5696 Tuscola Blvd
North Port, FL 34287-2738

Phone

(941) 257-0726

NPI assigned

Apr 24, 2023

Last updated

Sep 20, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1235827791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5696 TUSCOLA BLVD",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342872738",
            "telephone_number": "941-257-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5696 TUSCOLA BLVD",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342872738",
            "telephone_number": "941-257-0726"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1750 Tamiami Trl Ste 100",
            "address_purpose": "LOCATION",
            "city": "Port Charlotte",
            "state": "FL",
            "postal_code": "339481045",
            "country_code": "US",
            "telephone_number": "941-235-1001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANFREDO",
        "first_name": "IAN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN28617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brent Macphail, LMHC
• Amanda Maes
• Yasmin Mahmoud
• Mary Mahshie
• Sharose Mahshie, D.C.
• Karli Paige Manion, APRN
• Alanna Manning, P.T.
• Jammal Alexander Marcano Buret, MD
• Susan Marcello
• Nicholas Marino-Harris, RBT

• General Practice Dentistry in North Port, FL
• Providers in North Port, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.