Healthcare Provider Details

I. General information

NPI: 1235615022
Provider Name (Legal Business Name): CLAIRE KRUEGER MARTUCCI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR RM D1-17
GAINESVILLE FL
32610-2800
US

IV. Provider business mailing address

2000 SW 16TH ST APT 1
GAINESVILLE FL
32608-1437
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5430
  • Fax:
Mailing address:
  • Phone: 727-776-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDRPM1879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: