Mary Eileen Clemmons, RDH
Individual provider Active NPI Dental Hygienist · Patrick Afb, FL
NPI 1164575767 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164575767
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 0001982 (TX)
- Practice address
- 1381 S Patrick Dr
Patrick Afb, FL 32925-3606 - Phone
- (321) 494-6366
- Fax
- (321) 494-2068
- NPI assigned
- Jan 19, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0001982 | TX | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 0001982 | TX | Yes |
Addresses
Primary practice location
1381 S Patrick Dr
Patrick Afb, FL 32925-3606
Mailing address
1381 S Patrick Dr
Patrick Afb, FL 32925-3606
Phone (321) 494-6366
Other providers in Patrick Afb, FL
- Alesia Christen Carrizales
- Arthur Carrizales
- Elizabeth Cassidy
- Stephen Chase
- Joseph Edward Cheries
- Lisa Michelle Congdon
- Candace Nason Croft
- Austin S Davis
- Efrain A Delvalle
- Daniel Stephen Demick
All providers in Patrick Afb, FL · Dental Hygienist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.