Provider Demographics
NPI:1568684249
Name:NEBEL, CLIFFORD (DDS)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:NEBEL
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 1:2 CROSSBAR RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3909
Mailing Address - Country:US
Mailing Address - Phone:917-648-9677
Mailing Address - Fax:
Practice Address - Street 1:2 RUSSELL PL
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1509
Practice Address - Country:US
Practice Address - Phone:914-693-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0295571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice