Evelyn Clemente

Primary specialty

DentistTaxonomy code 122300000X

License

DN20701 Issued in FL

Practice address

2625 Roxboro Ave
Deltona, FL 32725-2271

Phone

(321) 284-7984

NPI assigned

Jun 12, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• Freedom Health HMO Network

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.

• Amazing Smile LLC

  • Dentist
  • Sanford, FL
  • NPI 1245637909
  NPD (past) Authorized official

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

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464652800000",
    "number": "1952715443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2417 S FRENCH AVE",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327714249",
            "telephone_number": "407-321-5010",
            "fax_number": "407-324-9229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 ROXBORO AVE",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327252271",
            "telephone_number": "321-284-7984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENTE",
        "first_name": "EVELYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-12",
        "last_updated": "2016-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN20701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Nicole Christman, PTA
• Donna E Cianciotto, PT
• John Joseph Ciotti Jr., RMHCI
• Circle of Friends Services Inc
• Suumadre Clark
• Jonathan Allen Cloud, CCRN RN
• Coast Florida P.a. (Coast Dental-Deltona)
• Courtny J. Coerver
• Miriamy Cofino, FNP-C
• Adam Cohen, LCSW

• Dentist in Deltona, FL
• Providers in Deltona, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.