Provider Demographics
NPI:1497061691
Name:LARSON-CLEMENTS, JUDY CAROL (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:CAROL
Last Name:LARSON-CLEMENTS
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W BELTLINE HWY
Mailing Address - Street 2:BOX A
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4226
Mailing Address - Country:US
Mailing Address - Phone:608-443-5480
Mailing Address - Fax:608-441-1981
Practice Address - Street 1:2901 W BELTLINE HWY
Practice Address - Street 2:BOX A
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4226
Practice Address - Country:US
Practice Address - Phone:608-443-5480
Practice Address - Fax:607-441-1981
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5747-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist