MEDICARE: ALEXIS LANDERS CLEMENT

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	20060	TX

General Provider Information

NPI Number	:	1548965270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS LANDERS CLEMENT

Provider Business Mailing Address
First Line	:	7401 LAKE POINT CIR
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-6016
Country	:	US
Telephone Number	:	501-773-9895
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 LAKE POINT CIR
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-6016
Country	:	US
Telephone Number	:	501-773-9895
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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Directions to “ ALEXIS LANDERS CLEMENT ” Practice Location

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