Provider Demographics
NPI:1568557155
Name:CHRISTI V. CLIFFORD D.D.S., PA
Entity Type:Organization
Organization Name:CHRISTI V. CLIFFORD D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-486-0440
Mailing Address - Street 1:903 BAY AREA BLVD.
Mailing Address - Street 2:STE. E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058
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:STE. E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-486-0440
Practice Address - Fax:281-486-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133304906Medicaid
TX17894*02OtherTEXAS CHIP