Individual
CLIFTON MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
609 ELM AVE, WACO, TX 76704
(254) 313-6960
(254) 313-4531
Mailing address
1600 PROVIDENCE DR, WACO, TX 76707-2261
(254) 313-4200
(254) 313-4326
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
14783
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090525901
—
TX
Enumeration date
09/15/2006
Last updated
02/02/2016
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