Provider Demographics
NPI:1063675460
Name:CLEMENT, NORMAN JESSE SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:JESSE
Last Name:CLEMENT
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20060 SANTA BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1278
Mailing Address - Country:US
Mailing Address - Phone:313-510-3378
Mailing Address - Fax:
Practice Address - Street 1:7481 WEST 7 MILE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221
Practice Address - Country:US
Practice Address - Phone:313-510-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist