Main Street Children's Dentistry and Orthodontics of Clermont, Pllc

NPI #1275982670 in Clermont, Florida

Provider Information

NPI Number: 1275982670
Entity Type: Organization
Organization Name: Main Street Children's Dentistry and Orthodontics of Clermont, Pllc
Primary Specialty: Dentist - Pediatric Dentistry
Enumeration Date: Jun 7, 2016
Last Updated: Jun 24, 2016

Practice Location

Address: 2410 E HIGHWAY 50, BLDG D, SUITE A
City: Clermont
State: Florida
ZIP Code: 34711
Phone: (305) 274-2499

Authorized Official

Name: STEPHANIE GOMEZ
Title: CREDENTIALING COORDINATOR
Phone: (305) 274-2499

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Pediatric Dentistry — Pediatric Dentistry	1223P0221X	Primary

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