Provider Demographics
NPI:1902830227
Name:R CLAUDIO DMD MD PA
Entity Type:Organization
Organization Name:R CLAUDIO DMD MD PA
Other - Org Name:ORAL & MAXILLOFACIAL SURGICAL SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RICHELE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAND GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-726-8500
Mailing Address - Street 1:2720 PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763
Mailing Address - Country:US
Mailing Address - Phone:727-726-8500
Mailing Address - Fax:727-725-9716
Practice Address - Street 1:2720 PARK DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763
Practice Address - Country:US
Practice Address - Phone:727-726-8500
Practice Address - Fax:727-725-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15004204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U77314Medicare UPIN
FLE3160Medicare ID - Type Unspecified