Provider Demographics
NPI:1881804433
Name:KLEMONS, GARY (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:KLEMONS
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 1:56 OLD MAIN ROAD
Mailing Address - Street 2:PO BOX 378
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959
Mailing Address - Country:US
Mailing Address - Phone:631-298-2000
Mailing Address - Fax:631-298-8309
Practice Address - Street 1:7905 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952
Practice Address - Country:US
Practice Address - Phone:631-298-2000
Practice Address - Fax:631-298-8309
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03686211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice