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General NPI Number Information
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NPI Number | 1073644068
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Entity Type | Organization
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Legal Business Name | MICHAEL E CLARKE DDSMS INC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 24 N CHURCH ST SUITE 206
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City | WAILUKU
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State | HI
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Zip | 96793-1680
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Country | US
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Telephone | 808-242-0077
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Fax | 808-243-8007
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Provider Business Mailing Address
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Address Line | 24 N CHURCH ST SUITE 206
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City | WAILUKU
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State | HI
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Zip | 96793-1680
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Country | US
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Telephone | 808-242-0077
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Fax | 808-243-8007
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL ELLSWORTH CLARKE
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Credential | D.D.S.,M. S.
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Telephone | 808-242-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State | HI
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