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General NPI Number Information
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NPI Number | 1023006426
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Entity Type | Organization
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Legal Business Name | CITRUS RIDGE DENTAL CENTER, PA
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 194 N HIGHWAY 27 SUITE F
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City | CLERMONT
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State | FL
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Zip | 34711-2448
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Country | US
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Telephone | 352-243-0018
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Fax | 352-243-6700
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Provider Business Mailing Address
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Address Line | 194 N HIGHWAY 27 SUITE F
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City | CLERMONT
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State | FL
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Zip | 34711-2448
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Country | US
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Telephone | 352-243-0018
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Fax | 352-243-6700
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRISTIN C KALWARA
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Credential | D.D.S.
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Telephone | 352-243-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | FL
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