NPIMap

Organization Active NPI

Clemons Cosmetic & Family Dentistry

  • Dental Clinic/Center
  • Durham, NC
National Provider Identifier
1235315771
Registry record updated Jun 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
5581 Issued in NC
Legal business name
CLEMONS COSMETIC & FAMILY DENTISTRY
Practice address
5011 Southpark Dr
Suite 110
Durham, NC 27713-7738
Phone
(919) 361-9700
Fax
(919) 361-9747
NPI assigned
Jan 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Edward Jacob Clemons Jr., DDSNPI 1831126309
Title
Owner/Dentist
Phone
(919) 361-9700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 5581 NC Primary

Addresses

Primary practice location

5011 Southpark Dr
Suite 110
Durham, NC 27713-7738

Mailing address

5011 Southpark Dr
Suite 110
Durham, NC 27713-7738
Phone (919) 361-9700

Other identifiers 2

IdentifierTypeStateIssuer
91662OtherNCBCBS
8991662MedicaidNC

Other names 1

  • Edward J. Clemons Jr., DDS, PA Other name

National Provider Directory

National Provider Directory

Locations

5011 Southpark Dr
Ste 110
Durham, NC 27713
Phone (919) 361-9700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1235315771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5011 SOUTHPARK DR",
            "address_2": "SUITE 110",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277137738",
            "telephone_number": "919-361-9700",
            "fax_number": "919-361-9747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5011 SOUTHPARK DR",
            "address_2": "SUITE 110",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277137738",
            "telephone_number": "919-361-9700",
            "fax_number": "919-361-9747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMONS COSMETIC & FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-15",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "CLEMONS",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "JACOB",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "919-361-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NC",
            "license": "5581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "91662",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8991662",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edward J. Clemons Jr., DDS, PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.