Healthcare Provider Details

I. General information

NPI: 1265479117
Provider Name (Legal Business Name): CLIFFORD S LEFFINGWELL III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S 40TH ST SUITE 214
LINCOLN NE
68506-5243
US

IV. Provider business mailing address

1919 S 40TH ST SUITE 214
LINCOLN NE
68506-5243
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-4380
  • Fax: 402-486-1278
Mailing address:
  • Phone: 402-486-4380
  • Fax: 402-486-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6571
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: