Provider Demographics
NPI:1447471727
Name:GROSS, CLIFFORD WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:WAYNE
Last Name:GROSS
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 1:699 DOLORO DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6828
Mailing Address - Country:US
Mailing Address - Phone:215-295-1251
Mailing Address - Fax:215-295-9360
Practice Address - Street 1:699 DOLORO DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-6828
Practice Address - Country:US
Practice Address - Phone:215-295-1251
Practice Address - Fax:215-295-9360
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026518L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000053555OtherUNITED CONCORDIA I.D.#