Individual
DR. LUCIOUS HENRY CLEMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9700 FORT KING RD, RICHMOND, VA 23229-3842
(804) 270-5033
Mailing address
9700 FORT KING RD, RICHMOND, VA 23229-3842
(804) 270-5033
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401003703
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401003703
VIRGINIA STATE BOARD OF DENTISTRY LICENSE
VA
01
—
FORMERLY 54-109-4553
FORMERLY L.HENRY CLEMONS D.D.S. PC ( NO LONGER CORPORATION) AND NO CORP TAX ID
VA
Enumeration date
07/30/2008
Last updated
07/30/2008
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