Healthcare Provider Details

I. General information

NPI: 1902830227
Provider Name (Legal Business Name): R CLAUDIO DMD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 PARK DR
CLEARWATER FL
33763
US

IV. Provider business mailing address

2720 PARK DR
CLEARWATER FL
33763
US

V. Phone/Fax

Practice location:
  • Phone: 727-726-8500
  • Fax: 727-725-9716
Mailing address:
  • Phone: 727-726-8500
  • Fax: 727-725-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number15004
License Number StateFL

VIII. Authorized Official

Name: MRS. RICHELE E RAND GREEN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 727-726-8500