Provider Demographics
NPI:1699975904
Name:CLEMENS, JUSTIN C (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:C
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 PERIMETER DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517
Mailing Address - Country:US
Mailing Address - Phone:859-268-1596
Mailing Address - Fax:859-977-7376
Practice Address - Street 1:620 PERIMETER DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517
Practice Address - Country:US
Practice Address - Phone:859-268-1596
Practice Address - Fax:859-977-7376
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY81671223P0300X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223P0221XDental ProvidersDentistPediatric Dentistry