Clermont Endodontic Specialist, PA

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

DN19410 Issued in FL

Legal business name

CLERMONT ENDODONTIC SPECIALIST, PA

Practice address

3207 S Florida Ave
Lakeland, FL 33803-4550

Phone

(863) 937-9181

NPI assigned

Dec 29, 2014

Organization subpart

Yes

Parent organization

CLERMONT ENDODONTIC SPECIALIST, PAAs reported in NPPES

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

Authorized official

Name

Kendra Walker

Title

Credentialing Coordinator

Phone

(217) 540-8312

Specialties & licenses 1

Addresses

Other names 1

• Lakeland Endodontics Doing business as

Part of

Clermont Endodontic Specialist PA

Locations

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

{
    "created_epoch": "1419811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419811200000",
    "number": "1649668682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034550",
            "telephone_number": "863-937-9181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034550",
            "telephone_number": "863-937-9181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLERMONT ENDODONTIC SPECIALIST, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLERMONT ENDODONTIC SPECIALIST, PA",
        "enumeration_date": "2014-12-29",
        "last_updated": "2014-12-29",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8312"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN19410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeland Endodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Belinda Cleaves
• Thomas Clem
• Clementine Behavioral Health, LLC
• Hana J. Clements, M.D
• Kristin Scott Clements
• Danielle Nikole Cleveland, ATC
• Kristy Cleveland
• Alexandra Izabel Clifford, BS
• Gloria Cline
• Clinical Research of Central Florida, Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; 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.