Provider Demographics
NPI:1619976172
Name:CLIFTON, JEFFREY ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:CLIFTON
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 1:163 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-3761
Mailing Address - Country:US
Mailing Address - Phone:434-797-9253
Mailing Address - Fax:
Practice Address - Street 1:770 PINEY FOREST RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2859
Practice Address - Country:US
Practice Address - Phone:434-799-8825
Practice Address - Fax:434-799-9458
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA463686OtherBCBS
VA0007805098Medicaid
VA014298OtherDORAL
VA923 08646CLIOtherOTHER