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General NPI Number Information
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NPI Number | 1205059441
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Entity Type | Organization
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Legal Business Name | CLARKE & FARMER DDS LTD
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1227 CEDARS CT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4800
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Country | US
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Telephone | 434-296-8043
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Fax | 434-296-1286
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Provider Business Mailing Address
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Address Line | 1227 CEDARS CT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4800
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Country | US
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Telephone | 434-296-8043
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Fax | 434-296-1286
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN M CLARKE
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Credential | DDS
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Telephone | 434-296-8043
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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 | 0401004067
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401005608
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401007444
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401411048
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License Number State | VA
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