Healthcare Provider Details

I. General information

NPI: 1801929492
Provider Name (Legal Business Name): STEPHEN J CLOUSE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLUMBUS STREET
SOMERSET OH
43783
US

IV. Provider business mailing address

400 S COLUMBUS STREET
SOMERSET OH
43783
US

V. Phone/Fax

Practice location:
  • Phone: 740-743-2566
  • Fax: 740-743-2567
Mailing address:
  • Phone: 740-743-2566
  • Fax: 740-743-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberOH 14930
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: