Individual
CLIFTON JORDAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2197 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-2038
(803) 531-1601
Mailing address
2197 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-2038
(803) 531-1601
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
SC4010
SC
1223G0001X
General Practice Dentistry
4010
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX4010
—
SC
Enumeration date
05/05/2006
Last updated
02/16/2011
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