Active NPI
Cecilia Perera
- Periodontics
- Clearwater, FL
National Provider Identifier
1154623379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DN19443
- Practice address
- 13501 Icot Blvd Ste 101
Clearwater, FL 33760-3729 - Phone
- (813) 407-3338
- NPI assigned
- Nov 19, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 30023354 | OH | |
| Periodontics | 1223P0300X | DN19443 | FL | Primary |
Addresses
Primary practice location
13501 Icot Blvd Ste 101
Clearwater, FL 33760-3729
Mailing address
13800 Veterans Way
Orlando, FL 32827-7403
Phone (813) 407-3338
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 |
|---|---|---|---|
| DN19443 | FL | MD | Periodontist |
| 30023354 | OH | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708560000000",
"number": "1154623379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13800 VETERANS WAY",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328277403",
"telephone_number": "813-407-3338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13501 ICOT BLVD STE 101",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337603729",
"telephone_number": "813-407-3338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERERA",
"first_name": "CECILIA",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-19",
"last_updated": "2024-02-22",
"certification_date": "2023-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OH",
"license": "30023354",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "FL",
"license": "DN19443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearwater, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.