Active NPI
Mana Watanabe
- General Practice Dentistry
- Tampa, FL
National Provider Identifier
1750818712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 24313
- Practice address
- 12950 Race Track Rd Ste 109
Tampa, FL 33626-1304 - Phone
- (813) 576-0200
- NPI assigned
- May 20, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 24313 | FL | Primary |
Addresses
Primary practice location
12950 Race Track Rd Ste 109
Tampa, FL 33626-1304
Mailing address
PO Box 291215
Tampa, FL 33687-1215
Phone (786) 540-0979
Other practice location 1
6747 Tyrone Sq
Saint Petersburg, FL 33710-3934
Phone (727) 345-6100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24313 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Faculty Associates, Inc | General Practice | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Hialeah, FL
- NPI 1770537953
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727136000000",
"number": "1750818712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 291215",
"city": "TAMPA",
"state": "FL",
"postal_code": "336871215",
"telephone_number": "786-540-0979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12950 RACE TRACK RD STE 109",
"city": "TAMPA",
"state": "FL",
"postal_code": "336261304",
"telephone_number": "813-576-0200"
}
],
"practiceLocations": [
{
"address_1": "6747 Tyrone Sq",
"address_purpose": "LOCATION",
"city": "Saint Petersburg",
"state": "FL",
"postal_code": "337103934",
"country_code": "US",
"telephone_number": "727-345-6100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WATANABE",
"first_name": "MANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-20",
"last_updated": "2024-09-24",
"certification_date": "2024-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "24313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.