Provider Demographics
NPI:1184724403
Name:CLEMMONS, JOSEPH V III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:V
Last Name:CLEMMONS
Suffix:III
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 1:6425 STAGE RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3731
Mailing Address - Country:US
Mailing Address - Phone:901-372-3555
Mailing Address - Fax:901-386-9849
Practice Address - Street 1:6425 STAGE RD
Practice Address - Street 2:SUITE #4
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3731
Practice Address - Country:US
Practice Address - Phone:901-372-3555
Practice Address - Fax:901-386-9849
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000047641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0160145OtherBC/BS OF TN
TN632057OtherUNITED CONCORDIA