Provider Demographics
NPI:1376218065
Name:SHIRECLIFFE, DAVID STREET (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STREET
Last Name:SHIRECLIFFE
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 1:280 PONAHAWAI ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3075
Mailing Address - Country:US
Mailing Address - Phone:808-935-5488
Mailing Address - Fax:
Practice Address - Street 1:425 PINE ST STE 3
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-2055
Practice Address - Country:US
Practice Address - Phone:209-745-4607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1084561223G0001X
HIDT-29341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice