Provider Demographics
NPI:1598827073
Name:CHARLES R CLIFFORD JR, DDS-WAYNE E FISCHER, DDS INC
Entity Type:Organization
Organization Name:CHARLES R CLIFFORD JR, DDS-WAYNE E FISCHER, DDS INC
Other - Org Name:M-RH FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-645-0396
Mailing Address - Street 1:3004 SUTTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3016
Mailing Address - Country:US
Mailing Address - Phone:314-645-0396
Mailing Address - Fax:314-645-6163
Practice Address - Street 1:3004 SUTTON BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-3016
Practice Address - Country:US
Practice Address - Phone:314-645-0396
Practice Address - Fax:314-645-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty