Individual
CLIFFORD DANIEL HEABERLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9775 SE SUNNYSIDE RD STE 200, CLACKAMAS, OR 97015-5721
(503) 655-8471
Mailing address
4211 N MISSISSIPPI AVE, PORTLAND, OR 97217-3132
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10706
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2017
Last updated
07/27/2017
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