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General NPI Number Information
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NPI Number | 1104156744
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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 | 01/04/2010
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Last Update Date | 01/04/2010
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Provider Practice Location Address
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Address Line | 1015 5TH ST
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City | MODESTO
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State | CA
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Zip | 95351-2810
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Country | US
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Telephone | 209-577-4263
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Fax | 209-577-2056
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Provider Business Mailing Address
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Address Line | 1015 5TH ST
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City | MODESTO
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State | CA
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Zip | 95351-2810
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Country | US
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Telephone | 209-577-4263
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Fax | 209-577-2056
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Authorized Official
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Title or Position | CORPORATION PRESIDENT
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Name | DR. DONALD CLARKE
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Credential | D.D.S.
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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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