Provider Demographics
NPI:1548470719
Name:HARRIS, CLIFTON LEE (DDS)
Entity type:Individual
Prefix:
First Name:CLIFTON
Middle Name:LEE
Last Name:HARRIS
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 1:500 MONTGOMERY ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1565
Mailing Address - Country:US
Mailing Address - Phone:703-836-7000
Mailing Address - Fax:703-836-7432
Practice Address - Street 1:500 MONTGOMERY ST
Practice Address - Street 2:SUITE 250
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1565
Practice Address - Country:US
Practice Address - Phone:703-836-7000
Practice Address - Fax:703-836-7432
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist