Provider Demographics
NPI:1255454682
Name:CLEMMONS, RUSSELL DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DEAN
Last Name:CLEMMONS
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 1:310 EISENHOWER DR
Mailing Address - Street 2:BLDG. #8
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-355-2050
Mailing Address - Fax:912-355-5367
Practice Address - Street 1:310 EISENHOWER DR
Practice Address - Street 2:BLDG. #8
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2632
Practice Address - Country:US
Practice Address - Phone:912-355-2050
Practice Address - Fax:912-355-5367
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0115171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice