Provider Demographics
NPI:1578972774
Name:CLEMENTS DENTAL PLLC
Entity Type:Organization
Organization Name:CLEMENTS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-685-9700
Mailing Address - Street 1:710 N BRITTAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3448
Mailing Address - Country:US
Mailing Address - Phone:931-685-9700
Mailing Address - Fax:931-685-4051
Practice Address - Street 1:710 N BRITTAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3448
Practice Address - Country:US
Practice Address - Phone:931-685-9700
Practice Address - Fax:931-685-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96711223G0001X
TN30461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty