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General NPI Number Information
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NPI Number | 1114467164
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Entity Type | Organization
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Legal Business Name | CONSOLIDATED ORTHODONTIC SERVICES, LLC
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 3 SILVER BROOK LN
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City | TORRINGTON
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State | CT
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Zip | 06790-7814
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Country | US
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Telephone | 860-866-6760
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Fax |
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Provider Business Mailing Address
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Address Line | 3 SILVER BROOK LN
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City | TORRINGTON
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State | CT
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Zip | 06790-7814
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Country | US
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Telephone | 860-866-6760
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK R CLAUSS
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Credential | DMD
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Telephone | 860-866-6760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 008877
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License Number State | CT
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