Provider Demographics
NPI:1306498316
Name:CLINEY, PAUL MATTHEW (RDH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MATTHEW
Last Name:CLINEY
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14710 38TH PL NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7709
Mailing Address - Country:US
Mailing Address - Phone:206-335-3664
Mailing Address - Fax:
Practice Address - Street 1:1722 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2504
Practice Address - Country:US
Practice Address - Phone:772-337-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24381124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist