Provider Demographics
NPI:1710502679
Name:MCCLEMENT, MATTHEW HENRY (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:HENRY
Last Name:MCCLEMENT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10918 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1018
Mailing Address - Country:US
Mailing Address - Phone:623-977-5227
Mailing Address - Fax:
Practice Address - Street 1:10918 W BELL RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1018
Practice Address - Country:US
Practice Address - Phone:623-977-5227
Practice Address - Fax:623-977-5229
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000364488122300000X
AZD010919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPP-000364488OtherTHE OHIO STATE UNIVERSITY