Provider Demographics
NPI:1134315583
Name:CLARY, ROLLINS (DMD)
Entity Type:Individual
Prefix:
First Name:ROLLINS
Middle Name:
Last Name:CLARY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116B BEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5743
Mailing Address - Country:US
Mailing Address - Phone:386-226-2268
Mailing Address - Fax:
Practice Address - Street 1:1116B BEVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5743
Practice Address - Country:US
Practice Address - Phone:386-226-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist