Basic Information
| Provider Information | |||||||||
| NPI: | 1790794808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAUSER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | GREGORY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5574 WOODSEDGE CT | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142212848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165602383 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1630 MAPLE RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142213706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165682273 | ||||||||
| FaxNumber: | 7165682047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 052390-1 | NY | Y | Dental Providers | Dentist | General Practice |
No ID Information.