Provider Demographics
NPI:1619907086
Name:DOMAN, CLIFF A (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLIFF
Middle Name:A
Last Name:DOMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 RUNNING CREEK WAY
Mailing Address - Street 2:BUILDING I
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5563
Mailing Address - Country:US
Mailing Address - Phone:801-768-0404
Mailing Address - Fax:801-766-0550
Practice Address - Street 1:3300 RUNNING CREEK WAY
Practice Address - Street 2:BUILDING I
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5563
Practice Address - Country:US
Practice Address - Phone:801-768-0404
Practice Address - Fax:801-766-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56429871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT272276391OtherTAX ID#