Provider Demographics
NPI:1821004664
Name:EFIRD, CLYDE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:S
Last Name:EFIRD
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 1:927 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-5220
Mailing Address - Country:US
Mailing Address - Phone:501-337-9559
Mailing Address - Fax:501-337-7447
Practice Address - Street 1:927 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-5220
Practice Address - Country:US
Practice Address - Phone:501-337-9559
Practice Address - Fax:501-337-7447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR20771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101436608Medicaid