Individual
MARY CLIFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
6226 14TH AVE, KENOSHA, WI 53143-4413
(262) 656-0044
(262) 764-3636
Mailing address
625 57TH ST, SUITE 700, KENOSHA, WI 53140-4146
(262) 764-3622
(262) 764-3636
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
5460-16
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922398387
—
WI
Enumeration date
04/19/2011
Last updated
11/11/2014
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