Provider Demographics
NPI:1245407832
Name:KLEMENT FAMILY DENTAL, P.A.
Entity Type:Organization
Organization Name:KLEMENT FAMILY DENTAL, P.A.
Other - Org Name:KLEMENT FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-343-8831
Mailing Address - Street 1:7650 38TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710
Mailing Address - Country:US
Mailing Address - Phone:727-343-8831
Mailing Address - Fax:727-345-5396
Practice Address - Street 1:7650 38TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-343-8831
Practice Address - Fax:727-345-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8208261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental