Provider Demographics
NPI:1457799256
Name:CLEMONS, ANNE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:FRAZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:9500 EUCLID AVE # A-71
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-6397
Mailing Address - Fax:216-445-8570
Practice Address - Street 1:9500 EUCLID AVE # A-71
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-6397
Practice Address - Fax:216-445-8570
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024270122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108355Medicaid