Provider Demographics
NPI:1174566376
Name:PERNELL, CLIFTON WADE
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:WADE
Last Name:PERNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 WEST 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658
Mailing Address - Country:US
Mailing Address - Phone:828-464-6220
Mailing Address - Fax:828-464-6232
Practice Address - Street 1:430 WEST 20TH STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658
Practice Address - Country:US
Practice Address - Phone:828-464-6220
Practice Address - Fax:828-464-6232
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice