Provider Demographics
NPI:1407964513
Name:DAINES, CLIFFORD DONALD (D D S)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:DONALD
Last Name:DAINES
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5974 FASHION POINT DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4699
Mailing Address - Country:US
Mailing Address - Phone:801-621-8440
Mailing Address - Fax:801-627-9063
Practice Address - Street 1:5974 FASHION POINT DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4699
Practice Address - Country:US
Practice Address - Phone:801-621-8440
Practice Address - Fax:801-627-9063
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143596-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice