Provider Demographics
NPI:1427516681
Name:KLIFFORD T KAPUS DDS., MSD A DENTAL CORPORATION
Entity type:Organization
Organization Name:KLIFFORD T KAPUS DDS., MSD A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KLIFFORD
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAPUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:925-443-3800
Mailing Address - Street 1:4200 EAST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4945
Mailing Address - Country:US
Mailing Address - Phone:925-443-3800
Mailing Address - Fax:925-443-3832
Practice Address - Street 1:4200 EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4945
Practice Address - Country:US
Practice Address - Phone:925-443-3800
Practice Address - Fax:925-443-3832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLIFFORD T KAPUS DDS., MSD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service