Provider Demographics
NPI:1356367510
Name:CLIFFORD, EUGENE M (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:M
Last Name:CLIFFORD
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 1:123 ELM ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4108
Mailing Address - Country:US
Mailing Address - Phone:860-388-0242
Mailing Address - Fax:
Practice Address - Street 1:123 ELM ST
Practice Address - Street 2:SUITE 900
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4108
Practice Address - Country:US
Practice Address - Phone:860-388-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4263OtherLICENSE NUMBER