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
1	122300000X	Dentist	30-024348	OH

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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