Provider Demographics
NPI:1770167272
Name:THOMAS M. CLEMENTS, DDS, INC.
Entity type:Organization
Organization Name:THOMAS M. CLEMENTS, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-722-9992
Mailing Address - Street 1:3006 STATE HIGHWAY 49 STE D
Mailing Address - Street 2:
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-9490
Mailing Address - Country:US
Mailing Address - Phone:530-888-6079
Mailing Address - Fax:
Practice Address - Street 1:3006 STATE HIGHWAY 49 STE D
Practice Address - Street 2:
Practice Address - City:COOL
Practice Address - State:CA
Practice Address - Zip Code:95614-9490
Practice Address - Country:US
Practice Address - Phone:530-888-6079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental