Provider Demographics
NPI:1477639334
Name:RAU, CLINT E (DDS)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:E
Last Name:RAU
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:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:WI
Mailing Address - Zip Code:54208-0560
Mailing Address - Country:US
Mailing Address - Phone:920-664-2424
Mailing Address - Fax:
Practice Address - Street 1:605 REED AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2026
Practice Address - Country:US
Practice Address - Phone:920-652-1100
Practice Address - Fax:920-652-1200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8109122300000X
WI6205-151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist