# CLEMENT RAINBOW MODERN DENTISTRY, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Rainbow Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477295368
- **Authorized official:** JENNIFER CLEMENT (OWNER/DMD)
- **Authorized official phone:** (701) 601-2196

## Contact information

- **Practice address:** 3675 S RAINBOW BLVD STE 105, LAS VEGAS, NV 89103-1059
- **Practice address phone:** (702) 602-2196
- **Practice address fax:** (702) 444-2325
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050
- **Mailing address phone:** (714) 845-8890
- **Mailing address fax:** (303) 952-0852

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/11/2022
- **Last updated:** 02/21/2023