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General NPI Number Information
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NPI Number | 1205932480
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Entity Type | Individual
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Provider Name | TRISCHA ANN CLARKE D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 940 NE 13TH ST RM 2102
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5008
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Country | US
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Telephone | 405-271-4750
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Fax | 405-271-4055
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Provider Business Mailing Address
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Address Line | 924 SW 36TH ST
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City | MOORE
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State | OK
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Zip | 73160-7696
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Country | US
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Telephone | 405-799-5675
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5859
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License Number State | OK
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