Provider Demographics
NPI:1821385543
Name:CATTANACH, JACLYN KUPPER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:KUPPER
Last Name:CATTANACH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:LAURA
Other - Last Name:KUPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3450
Mailing Address - Country:US
Mailing Address - Phone:860-539-9286
Mailing Address - Fax:
Practice Address - Street 1:155 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3450
Practice Address - Country:US
Practice Address - Phone:860-530-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5971C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice