Provider Demographics
NPI:1194800342
Name:CLEMENTS, KAREN FOX (DMD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:FOX
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:CLEMENTS
Other - Last Name:CRUNK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2415 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-4137
Mailing Address - Country:US
Mailing Address - Phone:205-556-6100
Mailing Address - Fax:205-556-6755
Practice Address - Street 1:2415 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-4137
Practice Address - Country:US
Practice Address - Phone:205-556-6100
Practice Address - Fax:205-556-6755
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-91211OtherBLUE CROSS/BLUE SHIELD AL