Provider Demographics
NPI:1831208677
Name:CLADER, DANIEL T (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:CLADER
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 1:601 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4207
Mailing Address - Country:US
Mailing Address - Phone:970-249-6955
Mailing Address - Fax:970-249-7309
Practice Address - Street 1:601 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4207
Practice Address - Country:US
Practice Address - Phone:970-249-6955
Practice Address - Fax:970-249-7309
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1053871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11636319Medicaid