Provider Demographics
NPI:1487662987
Name:CLEMENTS, CLINT A (DDS)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:A
Last Name:CLEMENTS
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 1:303 E HILDEBRAND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2475
Mailing Address - Country:US
Mailing Address - Phone:210-828-6357
Mailing Address - Fax:210-828-7460
Practice Address - Street 1:303 E HILDEBRAND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2475
Practice Address - Country:US
Practice Address - Phone:210-828-6357
Practice Address - Fax:210-828-7460
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice