Provider Demographics
NPI:1881630333
Name:CLIFTON W. PERNELL, DDS PA
Entity Type:Organization
Organization Name:CLIFTON W. PERNELL, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-464-6220
Mailing Address - Street 1:430 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3732
Mailing Address - Country:US
Mailing Address - Phone:828-464-6220
Mailing Address - Fax:
Practice Address - Street 1:430 W 20TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3732
Practice Address - Country:US
Practice Address - Phone:828-464-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty