Provider Demographics
NPI:1073657433
Name:BALL, CLIFTON LEE (DDS)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:LEE
Last Name:BALL
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 1:2912 MAPLEWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4010
Mailing Address - Country:US
Mailing Address - Phone:336-765-8940
Mailing Address - Fax:336-765-1473
Practice Address - Street 1:2912 MAPLEWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4010
Practice Address - Country:US
Practice Address - Phone:336-765-8940
Practice Address - Fax:336-765-1473
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC48301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice