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General NPI Number Information
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NPI Number | 1720683428
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Entity Type | Individual
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Provider Name | CAITLIN ROSE CLOUTIER DDS
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 836 FARMINGTON AVE STE 105
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1541
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Country | US
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Telephone | 860-459-2183
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Fax |
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Provider Business Mailing Address
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Address Line | 27 LAKESHORE DR APT A4
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City | FARMINGTON
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State | CT
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Zip | 06032-1263
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Country | US
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Telephone | 860-459-2183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12967
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12967
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License Number State | CT
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