Provider Demographics
NPI:1306856935
Name:CLIFFORD, CHRISTI VAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTI
Middle Name:VAN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 BAY AREA BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2647
Mailing Address - Country:US
Mailing Address - Phone:281-486-0440
Mailing Address - Fax:281-486-5918
Practice Address - Street 1:903 BAY AREA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2647
Practice Address - Country:US
Practice Address - Phone:281-486-0440
Practice Address - Fax:281-486-5918
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD17894OtherDELTA TX CHIP PROGRAM
TX133304906Medicaid