Clifford, Mary

Clifford, Mary is an individual health care provider with primary practice located at 6226 14Th Ave , Kenosha WI 53143-4413. She recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as her primary health care specialty. Clifford, Mary can be contacted via phone (262) 656-0044.

Contact Information

Primary practice address
6226 14Th Ave Kenosha WI 53143-4413
Fax: (262) 764-3636
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Hygienist 124Q00000X 5460-16 Wisconsin

Profile Details

NPI number 1922398387
LBN Legal business name Clifford, Mary
Credentials Registered Dental Hygienist (RDH)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 19th, 2011
Last updated Nov 11th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922398387 NPPES
Wisconsin MEDICAID 1922398387

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