Provider Demographics
NPI:1083886451
Name:MCLEMORE & MCLEMORE DDS COSMETIC AND FAMILY DENTISTRY
Entity type:Organization
Organization Name:MCLEMORE & MCLEMORE DDS COSMETIC AND FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-424-2651
Mailing Address - Street 1:211 OIL WELL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-424-2651
Mailing Address - Fax:731-424-2653
Practice Address - Street 1:211 OIL WELL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7924
Practice Address - Country:US
Practice Address - Phone:731-424-2651
Practice Address - Fax:731-424-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00839357OtherUNITED CONCORDIA
TN03153366OtherBCBS TN
TN01414019OtherUNITED CONCORDIA
TN0061546OtherBCBS OF TN
TN181433 LOCATION IDMedicaid
TN0061546OtherBCBS