Provider Demographics
NPI:1528201878
Name:CLIFFORD, LAWRENCE KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:KENNETH
Last Name:CLIFFORD
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 1:80 DECLARATION DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4913
Mailing Address - Country:US
Mailing Address - Phone:530-899-2634
Mailing Address - Fax:530-809-1318
Practice Address - Street 1:80 DECLARATION DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4913
Practice Address - Country:US
Practice Address - Phone:530-899-2634
Practice Address - Fax:530-809-1318
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist