1720292113 NPI number — CLEMENT V ADAMS II DDS PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720292113 NPI number — CLEMENT V ADAMS II DDS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEMENT V ADAMS II DDS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720292113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
G3192 LINDEN RD
Provider Second Line Business Mailing Address:
SUITE D112
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-732-4800
Provider Business Mailing Address Fax Number:
810-732-4800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
G3192 LINDEN RD
Provider Second Line Business Practice Location Address:
SUITE D112
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-732-4800
Provider Business Practice Location Address Fax Number:
810-732-4800
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
CLEMENT
Authorized Official Middle Name:
V
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
734-213-6400

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  2901016465 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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