Organization
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF CLERMONT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GOMEZ (CREDENTIALING COORDINATOR)
(305) 274-2499
Entity
Organization
Contact information
Practice address
2410 E HIGHWAY 50, BLDG D, SUITE A, CLERMONT, FL 34711
(305) 274-2499
Mailing address
13195 SW 134TH ST, MIAMI, FL 33186-4461
(305) 274-2499
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
06/07/2016
Last updated
06/24/2016
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