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General NPI Number Information
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NPI Number | 1881808475
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Entity Type | Organization
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Legal Business Name | MARK S. CLOTH DDS, PC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 N COALTER ST
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City | STAUNTON
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State | VA
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Zip | 24401-3401
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Country | US
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Telephone | 540-886-8331
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Fax | 540-886-8334
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Provider Business Mailing Address
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Address Line | 1912 RIVER INN LN
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-6203
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Country | US
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Telephone | 434-975-3013
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK STEPHEN CLOTH
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Credential | D.D.S.
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Telephone | 434-975-3013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401005851
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License Number State | VA
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