Provider Demographics
NPI:1659570158
Name:CLOUTIER, DAVID L (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:CLOUTIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NW LOOP 410 STE 515
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2259
Mailing Address - Country:US
Mailing Address - Phone:210-341-8281
Mailing Address - Fax:210-341-8282
Practice Address - Street 1:1100 NW LOOP 410 STE 515
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213
Practice Address - Country:US
Practice Address - Phone:210-341-8281
Practice Address - Fax:210-341-8282
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9027122300000X
TX264121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist