Provider Demographics
NPI:1770984585
Name:CLIFT, KAILA ALEXIS (DMD)
Entity type:Individual
Prefix:DR
First Name:KAILA
Middle Name:ALEXIS
Last Name:CLIFT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7814
Mailing Address - Country:US
Mailing Address - Phone:717-272-9552
Mailing Address - Fax:
Practice Address - Street 1:1230 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7814
Practice Address - Country:US
Practice Address - Phone:717-272-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist