MEDICARE: DR. CAROLINE CLERISME 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	DN124074	GA

General Provider Information

NPI Number	:	1518254135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE CLERISME D.M.D.

Provider Business Mailing Address
First Line	:	475 BROWN THRASHER CT
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-3674
Country	:	US
Telephone Number	:	781-526-6597
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 BROWN THRASHER CT
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-3674
Country	:	US
Telephone Number	:	781-526-6597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2011
Last Update Date	:	03/20/2026

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