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General NPI Number Information
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NPI Number | 1992720627
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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 | 07/13/2006
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 1930 9TH ST STE 105
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City | SACRAMENTO
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State | CA
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Zip | 95811-7076
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Country | US
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Telephone | 916-393-7336
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 9TH ST STE 105
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City | SACRAMENTO
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State | CA
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Zip | 95811-7076
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Country | US
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Telephone | 916-393-7336
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Fax | 916-393-6493
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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 | D.D.S.
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Telephone | 916-486-0117
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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 | 33738
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License Number State | CA
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