=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184153306
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA J CLAPSADDLE DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2017
-----------------------------------------------------
Last Update Date | 07/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 ASYLUM AVE STE 3203
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-714-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 STONEGATE RD
-----------------------------------------------------
City | OSSINING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10562-3939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-646-0303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12260
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------