Provider Demographics
NPI:1134124126
Name:CLIFFORD, PAUL MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARTIN
Last Name:CLIFFORD
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 1:7520 MONTGOMERY BLVD NE
Mailing Address - Street 2:BLDG D2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1533
Mailing Address - Country:US
Mailing Address - Phone:505-883-4865
Mailing Address - Fax:505-881-0113
Practice Address - Street 1:7520 MONTGOMERY BLVD NE
Practice Address - Street 2:BLDG D2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1533
Practice Address - Country:US
Practice Address - Phone:505-883-4865
Practice Address - Fax:505-881-0113
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist