MEDICARE: DR. CLIFFORD WESTON COOLIDGE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	24373	CA

General Provider Information

NPI Number	:	1861524340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFFORD WESTON COOLIDGE DDS

Provider Business Mailing Address
First Line	:	500 E REMINGTON DR
Second Line	:	#22
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-2657
Country	:	US
Telephone Number	:	408-736-4344
Fax Number	:	408-736-0560

Provider Business Practice Location Address
First Line	:	500 E REMINGTON DR
Second Line	:	#22
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-2657
Country	:	US
Telephone Number	:	408-736-4344
Fax Number	:	408-736-0560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2007
Last Update Date	:	07/08/2007

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