Provider Demographics
NPI:1336299239
Name:L. KENNETH CLIFFORD DDS, INC.
Entity Type:Organization
Organization Name:L. KENNETH CLIFFORD DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-877-0189
Mailing Address - Street 1:5910 CLARK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4856
Mailing Address - Country:US
Mailing Address - Phone:530-877-0189
Mailing Address - Fax:530-877-0187
Practice Address - Street 1:5910 CLARK RD
Practice Address - Street 2:SUITE A
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4856
Practice Address - Country:US
Practice Address - Phone:530-877-0189
Practice Address - Fax:530-877-0187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty