Provider Demographics
NPI:1740383207
Name:CLAUSEN, TROY R (DDS PC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:R
Last Name:CLAUSEN
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N166 WEST DR
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858
Mailing Address - Country:US
Mailing Address - Phone:906-863-9476
Mailing Address - Fax:906-863-3748
Practice Address - Street 1:N166 WEST DR
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858
Practice Address - Country:US
Practice Address - Phone:906-863-9476
Practice Address - Fax:906-863-3748
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist