PC Endo South PA

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

PC ENDO SOUTH PA

Doing business as

Advanced Endodontics

Practice address

1471 Johns Lake Rd Ste 1
Clermont, FL 34711-7005

Phone

(321) 204-6471

Fax

(407) 674-2539

NPI assigned

Jun 22, 2018

Organization subpart

No

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

Authorized official

Name

Lindsay Smock

Title

Director of Operations

Phone

(352) 404-5550

Specialties & licenses 1

Addresses

Other names 1

• Advanced Endodontics Doing business as

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

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1013402007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1471 JOHNS LAKE RD STE 1",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347117005",
            "telephone_number": "321-204-6471",
            "fax_number": "407-674-2539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1471 JOHNS LAKE RD STE 1",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347117005",
            "telephone_number": "321-204-6471",
            "fax_number": "407-674-2539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PC ENDO SOUTH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-22",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "SMOCK",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "352-404-5550"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Endodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Endodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patrick G Fairchild MD PA
• Brian Lee Patterson, MD
• Emily Marie Patterson, SLPA
• Paul McTurk LLC
• Laura R Paulk, MD
• PC Endo South PA
• PCP Clermont Opco LLC
• PCR-X Logistics LLC
• Peace in It Togeather
• Mariah Pearson

• Endodontics in Clermont, FL
• Providers in Clermont, FL by specialty
• Endodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.