Provider Demographics
NPI:1720683428
Name:CLOUTIER, CAITLIN ROSE (DDS)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ROSE
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LAKESHORE DR APT A4
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1263
Mailing Address - Country:US
Mailing Address - Phone:860-459-2183
Mailing Address - Fax:
Practice Address - Street 1:836 FARMINGTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1541
Practice Address - Country:US
Practice Address - Phone:860-459-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12967122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentistGroup - Single Specialty