Healthcare Provider Details

I. General information

NPI: 1699975904
Provider Name (Legal Business Name): JUSTIN C. CLEMENS DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 KINROSS LAKES PKWY STE 14
RICHFIELD OH
44286-9010
US

IV. Provider business mailing address

4199 KINROSS LAKES PKWY STE 14
RICHFIELD OH
44286-9010
US

V. Phone/Fax

Practice location:
  • Phone: 855-259-9183
  • Fax: 502-254-4076
Mailing address:
  • Phone: 855-259-9183
  • Fax: 502-254-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: