| Advanced Faces, LLC | |
|
855 Oakley Seaver Dr Clermont FL 34711-1968 | |
| (352) 242-0627 | |
| (352) 242-0648 |
| Full Name | Advanced Faces, LLC |
|---|---|
| Speciality | Dentist |
| Location | 855 Oakley Seaver Dr, Clermont, Florida |
| Authorized Official Name and Position | Christopher T Johnson (OWNER) |
| Authorized Official Contact | 3522420627 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Faces, LLC 855 Oakley Seaver Dr Clermont FL 34711-1968 Ph: (352) 242-0627 | Advanced Faces, LLC 855 Oakley Seaver Dr Clermont FL 34711-1968 Ph: (352) 242-0627 |
| NPI Number | 1669697025 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 10/18/2012 |
| Medicare PECOS PAC ID | 8921104571 |
|---|---|
| Medicare Enrollment ID | O20070428000061 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669697025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN14869 (Florida) | Primary |
| Provider Name | Christopher T Johnson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1467498253 PECOS PAC ID: 9638145386 Enrollment ID: I20040903000842 |
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