Provider Demographics
NPI:1437207560
Name:CLEMENT, DAVID J (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:CLEMENT
Suffix:
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 1:1201 N STONEWALL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1214
Mailing Address - Country:US
Mailing Address - Phone:405-271-5550
Mailing Address - Fax:
Practice Address - Street 1:1201 N STONEWALL AVE.
Practice Address - Street 2:OUHSC COLLEGE OF DENTISTRY
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117
Practice Address - Country:US
Practice Address - Phone:405-271-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55811223E0200X
TN94161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200080760Medicare ID - Type Unspecified