MEDICARE: DR. CLIFTON DAVISON 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	3441	CO

General Provider Information

NPI Number	:	1164514725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFTON DAVISON DDS

Provider Business Mailing Address
First Line	:	1513 RIVERSIDE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4348
Country	:	US
Telephone Number	:	970-484-4200
Fax Number	:	970-490-1490

Provider Business Practice Location Address
First Line	:	1513 RIVERSIDE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4348
Country	:	US
Telephone Number	:	970-484-4200
Fax Number	:	970-490-1490

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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