Provider Demographics
NPI:1134892284
Name:CLEMENTE ORTHODONTICS OF WOODCLIFF LAKE LLC
Entity type:Organization
Organization Name:CLEMENTE ORTHODONTICS OF WOODCLIFF LAKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-447-2888
Mailing Address - Street 1:595 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7663
Mailing Address - Country:US
Mailing Address - Phone:201-447-2888
Mailing Address - Fax:201-447-3834
Practice Address - Street 1:595 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-7663
Practice Address - Country:US
Practice Address - Phone:201-447-2888
Practice Address - Fax:201-447-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty