Provider Demographics
NPI:1770673287
Name:CLEM, DONALD S III (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:S
Last Name:CLEM
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:220 LAGUNA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2523
Mailing Address - Country:US
Mailing Address - Phone:714-441-0436
Mailing Address - Fax:714-441-0439
Practice Address - Street 1:220 LAGUNA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2523
Practice Address - Country:US
Practice Address - Phone:714-441-0436
Practice Address - Fax:714-441-0439
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA292401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics