Provider Demographics
NPI:1356780357
Name:CLEMENTS, TARA AMANDA (DDS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:AMANDA
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N BRITTAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3463
Mailing Address - Country:US
Mailing Address - Phone:931-685-9700
Mailing Address - Fax:931-685-4051
Practice Address - Street 1:710 N BRITTAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3463
Practice Address - Country:US
Practice Address - Phone:931-685-9700
Practice Address - Fax:931-685-4051
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist