Provider Demographics
NPI:1730343740
Name:CLEM, JOY D (DDS)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:D
Last Name:CLEM
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:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84317-0477
Mailing Address - Country:US
Mailing Address - Phone:801-745-1222
Mailing Address - Fax:801-745-1233
Practice Address - Street 1:237 S 7400 E
Practice Address - Street 2:BUILDING A
Practice Address - City:HUNTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84317-9722
Practice Address - Country:US
Practice Address - Phone:801-745-1222
Practice Address - Fax:801-745-1233
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5105713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist