Provider Demographics
NPI:1134261860
Name:CLOUSE, MICHAEL P JR (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:CLOUSE
Suffix:JR
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 1:114 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-0368
Mailing Address - Country:US
Mailing Address - Phone:740-743-2343
Mailing Address - Fax:
Practice Address - Street 1:114 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:OH
Practice Address - Zip Code:43783-0368
Practice Address - Country:US
Practice Address - Phone:740-743-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0134531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice