Provider Demographics
NPI:1548762834
Name:MCLEMORE, SAMUEL CLARK JR (DMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CLARK
Last Name:MCLEMORE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2312
Mailing Address - Country:US
Mailing Address - Phone:334-277-9570
Mailing Address - Fax:334-277-0152
Practice Address - Street 1:5740 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2312
Practice Address - Country:US
Practice Address - Phone:334-277-9570
Practice Address - Fax:334-277-0152
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL64951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty