Suncoast Oral Surgery & Periodontics

NPI #1700307220 in Venice, Florida

Provider Information

NPI Number: 1700307220
Entity Type: Organization
Organization Name: Suncoast Oral Surgery & Periodontics
Subpart: Yes (part of a larger organization)
Parent Organization: MEDALLION PERIODONTICS
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Jul 6, 2017
Last Updated: Jul 21, 2022

Practice Location

Address: 200 TAMIAMI TRL N
City: Venice
State: Florida
ZIP Code: 34285-1914
Phone: (941) 484-4001

Authorized Official

Name: MS. MARY CLEMENTS
Title: PRACTICE MANAGER
Phone: (863) 832-0028

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Periodontics — Periodontics	1223P0300X
Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	1223S0112X
Clinic/Center - Dental — Dental	261QD0000X	Primary

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