Provider Demographics
NPI:1558702399
Name:DEAN B CLEMENT, DPM, PLLC
Entity Type:Organization
Organization Name:DEAN B CLEMENT, DPM, PLLC
Other - Org Name:CLEMENT FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-529-2865
Mailing Address - Street 1:1343 N DELMAR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-4423
Mailing Address - Country:US
Mailing Address - Phone:480-529-2865
Mailing Address - Fax:
Practice Address - Street 1:5520 E MAIN ST
Practice Address - Street 2:#2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8793
Practice Address - Country:US
Practice Address - Phone:480-985-3730
Practice Address - Fax:480-985-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0593213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty