Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS-027772-L | PA |
NPI | 1033396999 |
---|---|
Provider Name | John W. Clemenza |
First Address | Hermitage, PA 16148-7905 |
Second Address | Hermitage, PA 16148-7905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2008 |
Last Update Date | 18/03/2008 |