Provider Demographics
NPI:1952074866
Name:CLEMENTS, JOSIAH NEWELL (DDS)
Entity Type:Individual
Prefix:
First Name:JOSIAH
Middle Name:NEWELL
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 HILDEBRAND LN NE STE 230
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3080
Mailing Address - Country:US
Mailing Address - Phone:206-780-1010
Mailing Address - Fax:
Practice Address - Street 1:945 HILDEBRAND LN NE STE 230
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3080
Practice Address - Country:US
Practice Address - Phone:206-780-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61161416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist