Provider Demographics
NPI:1427188101
Name:FISCUS, CLIFFORD W (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:W
Last Name:FISCUS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0632
Mailing Address - Country:US
Mailing Address - Phone:704-867-5702
Mailing Address - Fax:
Practice Address - Street 1:571 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0632
Practice Address - Country:US
Practice Address - Phone:704-867-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics