Provider Demographics
NPI:1215196761
Name:CALA HILLS ENDODONTICS
Entity Type:Organization
Organization Name:CALA HILLS ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LECORN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:352-291-9360
Mailing Address - Street 1:2130 SW 22ND PL STE 101
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7754
Mailing Address - Country:US
Mailing Address - Phone:352-291-9360
Mailing Address - Fax:352-291-9363
Practice Address - Street 1:2130 SW 22ND PL STE 101
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7754
Practice Address - Country:US
Practice Address - Phone:352-291-9360
Practice Address - Fax:352-291-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16008261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental