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General NPI Number Information
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NPI Number | 1659794956
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Entity Type | Organization
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Legal Business Name | PERIODOC, LLC
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 7320 FOREST OAKS BLVD
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City | SPRING HILL
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State | FL
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Zip | 34606-2401
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Country | US
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Telephone | 352-596-1771
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Fax | 352-596-6067
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Provider Business Mailing Address
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Address Line | 7320 FOREST OAKS BLVD
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City | SPRING HILL
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State | FL
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Zip | 34606-2401
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Country | US
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Telephone | 352-596-1771
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Fax | 352-596-6067
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JEFFREY ALAN HAMEROFF
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Credential | DDS
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Telephone | 352-596-1771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 10916
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License Number State | FL
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