Provider Demographics
NPI:1528005337
Name:MONROE, CLEMENT DUDLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:DUDLEY
Last Name:MONROE
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 1:12 REGIONAL DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8850
Mailing Address - Country:US
Mailing Address - Phone:910-295-4242
Mailing Address - Fax:910-295-5966
Practice Address - Street 1:12 REGIONAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8850
Practice Address - Country:US
Practice Address - Phone:910-295-4242
Practice Address - Fax:910-295-5966
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6455122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist