Provider Demographics
NPI:1376881888
Name:CLEMENS, GABRIEL G
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:G
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6593 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4724
Mailing Address - Country:US
Mailing Address - Phone:317-828-3266
Mailing Address - Fax:
Practice Address - Street 1:1499 WINDHORST WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8800
Practice Address - Country:US
Practice Address - Phone:888-309-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010846A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty