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NPI Code Detail

MEDICARE: DR. CLARISSA KATHRYN MCDERMOTT D.M.D.

MEDICARE:  DR. CLARISSA KATHRYN MCDERMOTT  D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist30-024348OH

General Provider Information

NPI Number : 1457693988
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLARISSA KATHRYN MCDERMOTT D.M.D.
Provider Business Mailing Address
First Line : 36900 DETROIT RD
Second Line : BUCKEYE DENTAL & BRACES
City : AVON
State : OH
Zip : 44011-1518
Country : US
Telephone Number : 440-934-3333
Fax Number :
Provider Business Practice Location Address
First Line : 36900 DETROIT RD
Second Line : BUCKEYE DENTAL & BRACES
City : AVON
State : OH
Zip : 44011-1518
Country : US
Telephone Number : 440-934-3333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2013
Last Update Date : 02/17/2015

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Directions to “ DR. CLARISSA KATHRYN MCDERMOTT D.M.D.” Practice Location

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