Provider Demographics
NPI:1407237852
Name:CLOUSE, AFTON
Entity Type:Individual
Prefix:
First Name:AFTON
Middle Name:
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 S POWER RD APT 1225
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3012
Mailing Address - Country:US
Mailing Address - Phone:602-540-3245
Mailing Address - Fax:
Practice Address - Street 1:1200 W WARNER RD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2758
Practice Address - Country:US
Practice Address - Phone:480-726-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant