Individual
CHAD CLIFTON STREET
Active
Individual
CHAD CLIFTON STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7103
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
38532
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1204662
CHA PROVIDER #
KY
05
—
60002300
—
KY
05
—
64068414
—
KY
Enumeration date
08/09/2006
Last updated
06/11/2014
Update your record
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