MEDICARE: TOWNCARE DENTAL OF CLERMONT, PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223P0221X	Pediatric Dentistry
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
4	1223E0200X	Endodontics
5	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
6	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1922398189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWNCARE DENTAL OF CLERMONT, PA

Provider Business Mailing Address
First Line	:	13195 SW 134TH ST FL 2
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4461
Country	:	US
Telephone Number	:	305-274-2499
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 E HWY 50
Second Line	:	SUITE 100
City	:	CLERMONT
State	:	FL
Zip	:	34711-5199
Country	:	US
Telephone Number	:	352-242-6222
Fax Number	:	352-242-0765

Authorized Official
Title or Position	:	PROVIDER RELATIONS SPECIALIST
Name	:	MS. STEPHANIE GOMEZ
Credential	:
Telephone Number	:	305-274-2499

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	08/04/2014

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