MEDICARE: EDWARD D CLIGHER DDS A PROFFESIONAL CORP

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	261QD0000X	Dental Clinic/Center	42290	CA

General Provider Information

NPI Number	:	1740682285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD D CLIGHER DDS A PROFFESIONAL CORP

Provider Business Mailing Address
First Line	:	17815 VENTURA BLVD
Second Line	:	SUITE 101
City	:	ENCINO
State	:	CA
Zip	:	91316-3610
Country	:	US
Telephone Number	:	818-708-1200
Fax Number	:	818-708-0046

Provider Business Practice Location Address
First Line	:	17815 VENTURA BLVD
Second Line	:	SUITE 101
City	:	ENCINO
State	:	CA
Zip	:	91316-3610
Country	:	US
Telephone Number	:	818-708-1200
Fax Number	:	818-708-0046

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. EDWARD DROR CLIGHER
Credential	:	DDS
Telephone Number	:	818-708-1200

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	09/16/2014

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