Provider Demographics
NPI:1134385149
Name:CLEMONS, LUCIOUS HENRY (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCIOUS
Middle Name:HENRY
Last Name:CLEMONS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:L.
Other - Middle Name:HENRY
Other - Last Name:CLEMONS D.D.S. PC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS,
Mailing Address - Street 1:9700 FORT KING RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-3842
Mailing Address - Country:US
Mailing Address - Phone:804-270-5033
Mailing Address - Fax:
Practice Address - Street 1:9700 FORT KING RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-3842
Practice Address - Country:US
Practice Address - Phone:804-270-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401003703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFORMERLY 54-109-4553OtherFORMERLY L.HENRY CLEMONS D.D.S. PC ( NO LONGER CORPORATION) AND NO CORP TAX ID
VA0401003703OtherVIRGINIA STATE BOARD OF DENTISTRY LICENSE