Provider Demographics
NPI:1083362537
Name:DONALD E. CLARKE, D.D.S., INC.
Entity Type:Organization
Organization Name:DONALD E. CLARKE, D.D.S., INC.
Other - Org Name:DENTAL SOURCE OF CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-487-0117
Mailing Address - Street 1:3901 MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3902
Mailing Address - Country:US
Mailing Address - Phone:916-487-0117
Mailing Address - Fax:
Practice Address - Street 1:25005 BLUE RAVINE RD STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-5706
Practice Address - Country:US
Practice Address - Phone:916-600-3719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental