Provider Demographics
NPI:1932212552
Name:KLEMENT, ROBERT A (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:KLEMENT
Suffix:
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 1:1310 RIVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5487
Mailing Address - Country:US
Mailing Address - Phone:715-421-3030
Mailing Address - Fax:715-421-3161
Practice Address - Street 1:1310 RIVER RUN DR
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5487
Practice Address - Country:US
Practice Address - Phone:715-421-3030
Practice Address - Fax:715-421-3161
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0002848-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist