Healthcare Provider Details

I. General information

NPI: 1235976994
Provider Name (Legal Business Name): ORAL SURGERY & DENTAL IMPLANT CENTER OF PANAMA CITY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 JENKS AVE
PANAMA CITY FL
32405-4311
US

IV. Provider business mailing address

2624 JENKS AVE
PANAMA CITY FL
32405-4311
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-0798
  • Fax:
Mailing address:
  • Phone: 850-215-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC R. CLAUSSEN
Title or Position: PARTNER
Credential: DMD
Phone: 407-408-4880