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General NPI Number Information
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NPI Number | 1083362537
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Entity Type | Organization
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Legal Business Name | DONALD E. CLARKE, D.D.S., INC.
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 25005 BLUE RAVINE RD STE 100
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City | FOLSOM
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State | CA
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Zip | 95630-5706
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Country | US
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Telephone | 916-600-3719
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 MARCONI AVE
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City | SACRAMENTO
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State | CA
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Zip | 95821-3902
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Country | US
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Telephone | 916-487-0117
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. DONALD CLARKE
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Credential | DDS
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Telephone | 916-487-0117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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