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General NPI Number Information
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NPI Number | 1730539552
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Entity Type | Individual
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Provider Name | KEVIN CLIFFORD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 302 N MAIN ST
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City | KAYSVILLE
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State | UT
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Zip | 84037-6766
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Country | US
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Telephone | 801-544-3953
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Fax |
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Provider Business Mailing Address
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Address Line | 134 S 400 E APT. 417
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-2160
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Country | US
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Telephone | 818-437-6370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9799604-9922
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License Number State | UT
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