Provider Demographics
NPI:1710051958
Name:MATTHEW J CLEMENTE DDS PC
Entity Type:Organization
Organization Name:MATTHEW J CLEMENTE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-237-2202
Mailing Address - Street 1:325 OAKWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182
Mailing Address - Country:US
Mailing Address - Phone:518-237-2202
Mailing Address - Fax:517-237-7371
Practice Address - Street 1:325 OAKWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182
Practice Address - Country:US
Practice Address - Phone:518-237-2202
Practice Address - Fax:517-237-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty