Provider Demographics
NPI:1235260076
Name:CLARKE, RICHARD ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROY
Last Name:CLARKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 N SAGINAW RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2387
Mailing Address - Country:US
Mailing Address - Phone:989-631-7550
Mailing Address - Fax:989-923-1180
Practice Address - Street 1:4604 N SAGINAW RD
Practice Address - Street 2:SUITE D
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2387
Practice Address - Country:US
Practice Address - Phone:989-631-7550
Practice Address - Fax:989-923-1180
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI135961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice