Provider Demographics
NPI:1841464971
Name:CLEMENT, JERRY T (DDS)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:T
Last Name:CLEMENT
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 1:3640 LOMITA BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3927
Mailing Address - Country:US
Mailing Address - Phone:310-791-4100
Mailing Address - Fax:310-791-4097
Practice Address - Street 1:3640 LOMITA BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3927
Practice Address - Country:US
Practice Address - Phone:310-791-4100
Practice Address - Fax:310-791-4097
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist