Provider Demographics
NPI:1639716475
Name:CHAD E. CLEMENT, DDS, PC
Entity Type:Organization
Organization Name:CHAD E. CLEMENT, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-997-3423
Mailing Address - Street 1:PO BOX 1487
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0075
Mailing Address - Country:US
Mailing Address - Phone:541-997-3423
Mailing Address - Fax:541-997-8749
Practice Address - Street 1:1256 BAY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9648
Practice Address - Country:US
Practice Address - Phone:541-997-3423
Practice Address - Fax:541-997-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental