Provider Demographics
NPI:1891530895
Name:CLERMONT PERIODONTICS AND IMPLANT CENTER PLLC
Entity type:Organization
Organization Name:CLERMONT PERIODONTICS AND IMPLANT CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERWIN
Authorized Official - Middle Name:OMARRE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, CHP
Authorized Official - Phone:731-313-0998
Mailing Address - Street 1:17522 PROMENADE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5894
Mailing Address - Country:US
Mailing Address - Phone:731-313-0998
Mailing Address - Fax:
Practice Address - Street 1:1381 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1957
Practice Address - Country:US
Practice Address - Phone:731-313-0998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty