Provider Demographics
NPI:1033382841
Name:RADCLIFF, DANNA
Entity Type:Individual
Prefix:DR
First Name:DANNA
Middle Name:
Last Name:RADCLIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-3409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:696 HIGHWAY 71 W
Practice Address - Street 2:BUILDING 4, UNIT D
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4009
Practice Address - Country:US
Practice Address - Phone:512-321-5437
Practice Address - Fax:888-317-1936
Is Sole Proprietor?:No
Enumeration Date:2008-04-12
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX213531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry