Provider Demographics
NPI:1740660836
Name:CLIFFORD, TERAH (RDH)
Entity type:Individual
Prefix:MRS
First Name:TERAH
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W DL INGRAM BLVD
Mailing Address - Street 2:BLDG 1408 DENTAL CLINIC
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103
Mailing Address - Country:US
Mailing Address - Phone:575-784-4041
Mailing Address - Fax:
Practice Address - Street 1:224 W DL INGRAM BLVD
Practice Address - Street 2:BLDG 1408 DENTAL CLINIC
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:575-784-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9550124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist