Provider Demographics
NPI:1831505221
Name:CLEMENS, MCKENZIE ASHLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:MCKENZIE
Middle Name:ASHLEY
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1030
Mailing Address - Country:US
Mailing Address - Phone:518-785-3084
Mailing Address - Fax:
Practice Address - Street 1:1201 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1030
Practice Address - Country:US
Practice Address - Phone:518-785-3084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057999-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist