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General NPI Number Information
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NPI Number | 1952504219
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Entity Type | Individual
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Provider Name | JUSTIN BICE CLEMOW D.M.D., M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 2500 W STRUB RD STE A
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City | SANDUSKY
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State | OH
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Zip | 44870-5390
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Country | US
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Telephone | 419-627-8131
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 W STRUB RD STE A
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City | SANDUSKY
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State | OH
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Zip | 44870-5390
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Country | US
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Telephone | 419-627-8131
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 023915
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DN18025
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 30.023915
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 35.121660
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DN1856941
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License Number State | MA
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Taxonomy #6
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 264666
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License Number State | MA
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