Provider Demographics
NPI:1871640888
Name:CLEMMONS, BILLY KEVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:KEVIN
Last Name:CLEMMONS
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 1:1099 DENHAM RD
Mailing Address - Street 2:
Mailing Address - City:SMITHS GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42171-7261
Mailing Address - Country:US
Mailing Address - Phone:270-597-2643
Mailing Address - Fax:270-746-5944
Practice Address - Street 1:1042 FAIRVIEW AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-1677
Practice Address - Country:US
Practice Address - Phone:270-746-5880
Practice Address - Fax:270-746-5944
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60060134Medicaid
KY60060134Medicaid