Provider Demographics
NPI:1861806069
Name:CLIFFORD, GREGORY MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARK
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 N NICKLAS AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6907
Mailing Address - Country:US
Mailing Address - Phone:405-820-9457
Mailing Address - Fax:
Practice Address - Street 1:13100 CLNY POINTE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-8827
Practice Address - Country:US
Practice Address - Phone:405-820-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist