Healthcare Provider Details

I. General information

NPI: 1992064349
Provider Name (Legal Business Name): TRENT C CLIFTON DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 BOBCAT WAY
GREAT FALLS MT
59405
US

IV. Provider business mailing address

2511 BOBCAT WAY
GREAT FALLS MT
59405
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-4322
  • Fax: 406-771-1516
Mailing address:
  • Phone: 406-727-4322
  • Fax: 406-771-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9227
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15418
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9227
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number66167
License Number StateMT
# 5
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15418
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: