Provider Demographics
NPI:1093381220
Name:CLIFFORD, CHARU (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARU
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHARU
Other - Middle Name:
Other - Last Name:GAMBHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:500 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-3210
Mailing Address - Country:US
Mailing Address - Phone:843-479-4781
Mailing Address - Fax:
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-3210
Practice Address - Country:US
Practice Address - Phone:843-479-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.98871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice