Provider Demographics
NPI:1457575052
Name:CLAUSS, KELLY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:CLAUSS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PECK RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6106
Mailing Address - Country:US
Mailing Address - Phone:860-482-8588
Mailing Address - Fax:860-482-7596
Practice Address - Street 1:55 PECK RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6106
Practice Address - Country:US
Practice Address - Phone:860-482-8588
Practice Address - Fax:860-482-7596
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051976-1122300000X
CT0088731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist