Provider Demographics
NPI:1265676399
Name:HOSTETLER, CLIFFORD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:R
Last Name:HOSTETLER
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 1:1119 GRANVILLE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6226
Mailing Address - Country:US
Mailing Address - Phone:949-644-1141
Mailing Address - Fax:949-644-1165
Practice Address - Street 1:1119 GRANVILLE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6226
Practice Address - Country:US
Practice Address - Phone:949-644-1141
Practice Address - Fax:949-644-1165
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist