Provider Demographics
NPI:1588193601
Name:CLEMENT, CARA NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:NICOLE
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:HAWARDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51023-2142
Mailing Address - Country:US
Mailing Address - Phone:712-540-8925
Mailing Address - Fax:
Practice Address - Street 1:810 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HAWARDEN
Practice Address - State:IA
Practice Address - Zip Code:51023-2232
Practice Address - Country:US
Practice Address - Phone:712-551-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-094101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice