Provider Demographics
NPI:1841393386
Name:KLEMONS, IRA M (DDS PHD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:M
Last Name:KLEMONS
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2069
Mailing Address - Country:US
Mailing Address - Phone:732-727-5000
Mailing Address - Fax:732-525-8566
Practice Address - Street 1:2045 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2069
Practice Address - Country:US
Practice Address - Phone:732-727-5000
Practice Address - Fax:732-525-8566
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096787OtherMEDICARE PIN GROUP #
NJ520804OtherRENDERING UVE
NJ5530690001OtherDMEPOS
NJ096787OtherMEDICARE PIN GROUP #
NJT50397Medicare ID - Type Unspecified