Provider Demographics
NPI:1235481102
Name:INGABIRE, CLEMENTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLEMENTINE
Middle Name:
Last Name:INGABIRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-1158
Mailing Address - Country:US
Mailing Address - Phone:713-738-1999
Mailing Address - Fax:713-738-2085
Practice Address - Street 1:4040 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-1158
Practice Address - Country:US
Practice Address - Phone:713-738-1999
Practice Address - Fax:713-738-2085
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist