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

(352) 404-5550

NPI assigned

May 26, 2015

Organization subpart

No

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

Authorized official

Name

Amber Mae Perry

Title

Cfo

Phone

(352) 404-5550

Specialties & licenses 2

Addresses

Other names 1

• Advanced Endodontics Doing business as

Locations

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

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579651200000",
    "number": "1942689807",
    "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": "352-404-5550"
        },
        {
            "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": "352-404-5550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "835 7th St Ste 6",
            "address_purpose": "LOCATION",
            "city": "Clermont",
            "state": "FL",
            "postal_code": "347112190",
            "country_code": "US",
            "telephone_number": "352-404-5550",
            "fax_number": "407-674-2539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PC ENDO SOUTH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-26",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "352-404-5550"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Endodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Endodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Kelly Pecora

• 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 Jan 22, 2020; 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.