Provider Demographics
NPI:1023006426
Name:CITRUS RIDGE DENTAL CENTER, PA
Entity Type:Organization
Organization Name:CITRUS RIDGE DENTAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KALWARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-243-0018
Mailing Address - Street 1:194 N HIGHWAY 27
Mailing Address - Street 2:SUITE F
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2448
Mailing Address - Country:US
Mailing Address - Phone:352-243-0018
Mailing Address - Fax:352-243-6700
Practice Address - Street 1:194 N HIGHWAY 27
Practice Address - Street 2:SUITE F
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2448
Practice Address - Country:US
Practice Address - Phone:352-243-0018
Practice Address - Fax:352-243-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty