Provider Demographics
NPI:1427342328
Name:CLEM, GENE CALVIN III (DDS)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:CALVIN
Last Name:CLEM
Suffix:III
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:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-0284
Mailing Address - Country:US
Mailing Address - Phone:301-689-3677
Mailing Address - Fax:301-689-3477
Practice Address - Street 1:16920 NATIONAL HWY SW
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-3306
Practice Address - Country:US
Practice Address - Phone:301-689-3677
Practice Address - Fax:301-689-3477
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist