Organization
CLERMONT ENDODONTIC SPECIALIST, PA
Active
Parent organization
CLERMONT ENDODONTIC SPECIALIST, PA
Other names
Lakeland Endodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLERMONT ENDODONTIC SPECIALIST, PA
Authorized official
KENDRA WALKER (CREDENTIALING COORDINATOR)
(217) 540-8312
Entity
Organization
Contact information
Practice address
3207 S FLORIDA AVE, LAKELAND, FL 33803-4550
(863) 937-9181
Mailing address
3207 S FLORIDA AVE, LAKELAND, FL 33803-4550
(863) 937-9181
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DN19410
FL
Other
Enumeration date
12/29/2014
Last updated
12/29/2014
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