Provider Demographics
NPI:1861446155
Name:LACLAIR, ROBERT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:LACLAIR
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 1:775 GRAVES STREET
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:13624
Mailing Address - Country:US
Mailing Address - Phone:315-686-5142
Mailing Address - Fax:315-686-2310
Practice Address - Street 1:775 GRAVES STREET
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NY
Practice Address - Zip Code:13624
Practice Address - Country:US
Practice Address - Phone:315-686-5142
Practice Address - Fax:315-686-2310
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02558285Medicaid