Provider Demographics
NPI:1053106195
Name:MID-FLORIDA ENDODONTICS - CLERMONT, PLLC
Entity type:Organization
Organization Name:MID-FLORIDA ENDODONTICS - CLERMONT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DU LAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-803-2356
Mailing Address - Street 1:2855 W STATE ROAD 434 STE 1021
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4480
Mailing Address - Country:US
Mailing Address - Phone:407-788-8880
Mailing Address - Fax:407-788-3901
Practice Address - Street 1:2621 S US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6130
Practice Address - Country:US
Practice Address - Phone:689-304-2501
Practice Address - Fax:689-304-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty