Healthcare Provider Details

I. General information

NPI: 1922448117
Provider Name (Legal Business Name): JENNIFER MARIE CLEMENTE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE HOMER DDS

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4094
US

IV. Provider business mailing address

6306 OKINAWA DR
COLORADO SPRINGS CO
80902-3225
US

V. Phone/Fax

Practice location:
  • Phone: 719-327-5660
  • Fax:
Mailing address:
  • Phone: 262-227-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7080-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015596
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN25620
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7080-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: