| Entity Name: | CLERMONT PERIODONTICS AND IMPLANT CENTER, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Feb 2024 (a year ago) |
| Document Number: | L24000059757 |
| Mail Address: | PO BOX 4027, ORMOND BEACH, FL, 32175, US |
| Address: | 700 W GRANADA BLVD, 100, ORMOND BEACH, FL, 32174, US |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891530895 | 2024-07-01 | 2024-07-01 | 17522 PROMENADE DR, CLERMONT, FL, 347115894, US | 1381 CITRUS TOWER BLVD, CLERMONT, FL, 347111957, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 731-313-0998 |
Authorized person
| Name | DR. KERWIN OMARRE SCOTT |
| Role | OWNER |
| Phone | 7313130998 |
Taxonomy
| Taxonomy Code | 1223P0300X - Periodontist |
| Is Primary | Yes |
| Name | Role |
|---|---|
| THE RICHARDS LAW GROUP, PLLC | Agent |
| Name | Role |
|---|---|
| THE RICHARDS LAW GROUP, PLLC | Authorized Representative |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-02-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
