Provider Demographics
NPI:1902394182
Name:CLUFF DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:CLUFF DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CLUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-443-3948
Mailing Address - Street 1:9447 WINTER GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-4540
Mailing Address - Country:US
Mailing Address - Phone:619-443-3948
Mailing Address - Fax:619-443-3938
Practice Address - Street 1:9447 WINTER GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-4540
Practice Address - Country:US
Practice Address - Phone:619-443-3948
Practice Address - Fax:619-443-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty