Provider Demographics
NPI:1821456609
Name:CLEMENTE, NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3197
Mailing Address - Country:US
Mailing Address - Phone:201-447-2888
Mailing Address - Fax:201-447-3834
Practice Address - Street 1:60 W RIDGEWOOD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3197
Practice Address - Country:US
Practice Address - Phone:201-447-2888
Practice Address - Fax:201-447-3834
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ219221223X0400X
NY0499711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics