Healthcare Provider Details

I. General information

NPI: 1134155690
Provider Name (Legal Business Name): KLIFFORD TODD KAPUS DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 EAST AVE SUITE #100
LIVERMORE CA
94550-4945
US

IV. Provider business mailing address

4200 EAST AVE SUITE #100
LIVERMORE CA
94550-4945
US

V. Phone/Fax

Practice location:
  • Phone: 925-443-3800
  • Fax: 925-443-3832
Mailing address:
  • Phone: 925-443-3800
  • Fax: 925-443-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number44712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: