Provider Demographics
NPI:1083774848
Name:JUE, CLIFFORD HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:HAROLD
Last Name:JUE
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 1:125 E BARSTOW AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-227-5309
Mailing Address - Fax:559-227-7934
Practice Address - Street 1:125 E BARSTOW AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-227-5309
Practice Address - Fax:559-227-7934
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB1923001OtherDENTICAL STATE OF CA
CA19230OtherSTATE OF CALIFORNIA