Healthcare Provider Details

I. General information

NPI: 1952310526
Provider Name (Legal Business Name): CLIFFORD L. THOMAS DDS., MS.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14601 DETROIT AVE #620
LAKEWOOD OH
44107-4214
US

IV. Provider business mailing address

14601 DETROIT AVE #620
LAKEWOOD OH
44107-4214
US

V. Phone/Fax

Practice location:
  • Phone: 216-221-5595
  • Fax: 216-221-7147
Mailing address:
  • Phone: 216-221-5595
  • Fax: 216-221-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number19720
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: