Individual
DR. PAUL DOUGLAS NIFONG JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3624 CLEMMONS RD., CLEMMONS, NC 27012-8873
(336) 766-6457
Mailing address
PO BOX 325, CLEMMONS, NC 27012-0325
(336) 766-6457
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4520
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
899451
—
NC
Enumeration date
07/31/2006
Last updated
07/08/2007
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