MEDICARE: DR. NORMAN JESSE CLEMENT SR. 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	122300000X	Dentist	2901013406	MI

General Provider Information

NPI Number	:	1063675460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN JESSE CLEMENT SR. DDS

Provider Business Mailing Address
First Line	:	20060 SANTA BARBARA DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1278
Country	:	US
Telephone Number	:	313-510-3378
Fax Number	:

Provider Business Practice Location Address
First Line	:	7481 WEST 7 MILE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221
Country	:	US
Telephone Number	:	313-510-3378
Fax Number	:

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

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	07/07/2008

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