Provider Demographics
NPI:1316987563
Name:CLIFFORD, JOHN M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 M ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4501
Mailing Address - Country:US
Mailing Address - Phone:253-833-9062
Mailing Address - Fax:253-351-0503
Practice Address - Street 1:620 M ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4501
Practice Address - Country:US
Practice Address - Phone:253-833-9062
Practice Address - Fax:253-351-0503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000056961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice