Provider Demographics
NPI:1811281991
Name:CLIFFORD, AMANDA M (DDS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 S CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5608
Mailing Address - Country:US
Mailing Address - Phone:262-784-2449
Mailing Address - Fax:
Practice Address - Street 1:6425 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4939
Practice Address - Country:US
Practice Address - Phone:414-914-7000
Practice Address - Fax:414-914-8000
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6755-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist