Healthcare Provider Details

I. General information

NPI: 1528005337
Provider Name (Legal Business Name): CLEMENT DUDLEY MONROE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 REGIONAL DR
PINEHURST NC
28374-8850
US

IV. Provider business mailing address

12 REGIONAL DR
PINEHURST NC
28374-8850
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-4242
  • Fax: 910-295-5966
Mailing address:
  • Phone: 910-295-4242
  • Fax: 910-295-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6455
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: