Healthcare Provider Details

I. General information

NPI: 1497266092
Provider Name (Legal Business Name): KEROLOS RAGAEY HELMY ELSAYED BDS,DMD,MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 HATTERAS AVE UNIT 2
CLERMONT FL
34711-7400
US

IV. Provider business mailing address

10007 WELLNESS WAY
ORLANDO FL
32832-7173
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0150
  • Fax:
Mailing address:
  • Phone: 407-704-7863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN27839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: