Provider Demographics
NPI:1992064349
Name:CLIFTON, TRENT C (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:C
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 BOBCAT WAY
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-727-4322
Mailing Address - Fax:406-771-1516
Practice Address - Street 1:2511 BOBCAT WAY
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-727-4322
Practice Address - Fax:406-771-1516
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT154181223G0001X, 1223S0112X
KY9227122300000X, 1223S0112X
MT661671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist