Organization
SUNCOAST ORAL SURGERY & PERIODONTICS
Active
Parent organization
MEDALLION PERIODONTICS
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDALLION PERIODONTICS
Authorized official
MS. MARY CLEMENTS (PRACTICE MANAGER)
(863) 832-0028
Entity
Organization
Contact information
Practice address
200 TAMIAMI TRL N, VENICE, FL 34285-1914
(941) 484-4001
Mailing address
200 TAMIAMI TRL N, VENICE, FL 34285-1914
(941) 484-4001
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/06/2017
Last updated
07/21/2022
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