Basic Information
| Provider Information | |||||||||
| NPI: | 1306498316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLINEY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14710 38TH PL NE | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST PARK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981557709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063353664 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1722 SW SAINT LUCIE WEST BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349862504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723378600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 24381 | FL | Y | Dental Providers | Dental Hygienist |
No ID Information.