Provider Demographics
NPI:1760642706
Name:CLEMENTS, BRANDON R (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:R
Last Name:CLEMENTS
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 1:2487 DEMERE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5639
Mailing Address - Country:US
Mailing Address - Phone:912-638-9921
Mailing Address - Fax:912-638-4121
Practice Address - Street 1:2487 DEMERE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-5639
Practice Address - Country:US
Practice Address - Phone:912-638-9921
Practice Address - Fax:912-638-4121
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice