Provider Demographics
NPI:1073673976
Name:VANBLARCOM, CLIFFORD WINTERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:WINTERS
Last Name:VANBLARCOM
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 1:6834 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-1426
Mailing Address - Country:US
Mailing Address - Phone:913-432-5025
Mailing Address - Fax:
Practice Address - Street 1:6834 LINDEN ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-1426
Practice Address - Country:US
Practice Address - Phone:913-432-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS48751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics