Provider Demographics
NPI:1922393156
Name:CLEM, NATHAN FREEMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:FREEMAN
Last Name:CLEM
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 1:384 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3527
Mailing Address - Country:US
Mailing Address - Phone:631-993-4493
Mailing Address - Fax:
Practice Address - Street 1:384 LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3527
Practice Address - Country:US
Practice Address - Phone:316-993-4493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0616031223G0001X
NMDD35001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice