Provider Demographics
NPI:1932586856
Name:CLIVE, GEOFFREY RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:RICHARD
Last Name:CLIVE
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 1:11082 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6692
Mailing Address - Country:US
Mailing Address - Phone:503-654-3456
Mailing Address - Fax:
Practice Address - Street 1:11082 SE OAK ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6692
Practice Address - Country:US
Practice Address - Phone:503-654-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15837122300000X
OR110391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist