Provider Demographics
NPI:1306040324
Name:CLEMENT, MARSHA HARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:HARRIS
Last Name:CLEMENT
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 1:624 CHENE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207
Mailing Address - Country:US
Mailing Address - Phone:313-567-6200
Mailing Address - Fax:313-567-6202
Practice Address - Street 1:624 CHENE ST
Practice Address - Street 2:ELMWOOD PARK DENTAL PC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-567-6200
Practice Address - Fax:313-567-6202
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist