MEDICARE: CLEMENT JAMES CONTESTABLE DMD

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	1223G0001X	General Practice Dentistry	DN19066	FL

General Provider Information

NPI Number	:	1811208853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEMENT JAMES CONTESTABLE DMD

Provider Business Mailing Address
First Line	:	100 S EOLA DR UNIT 508
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-2892
Country	:	US
Telephone Number	:	321-356-5497
Fax Number	:

Provider Business Practice Location Address
First Line	:	4307 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5217
Country	:	US
Telephone Number	:	407-362-7705
Fax Number	:

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	04/25/2023

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