MEDICARE: DR. BRUCE PHILIP CLEMENT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00006349	WA

General Provider Information

NPI Number	:	1033249834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE PHILIP CLEMENT DDS

Provider Business Mailing Address
First Line	:	3340 NE 125TH ST
Second Line	:	SUITE 2
City	:	SEATTLE
State	:	WA
Zip	:	98125-8911
Country	:	US
Telephone Number	:	206-363-6696
Fax Number	:	206-363-0072

Provider Business Practice Location Address
First Line	:	3340 NE 125TH ST
Second Line	:	SUITE 2
City	:	SEATTLE
State	:	WA
Zip	:	98125-8911
Country	:	US
Telephone Number	:	206-363-6696
Fax Number	:	206-363-0072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2007

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