Provider Demographics
NPI:1417681784
Name:PAUL S CLARKE IV, DMD, PLLC #2
Entity Type:Organization
Organization Name:PAUL S CLARKE IV, DMD, PLLC #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-930-3687
Mailing Address - Street 1:3461 US HIGHWAY 601 S
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0490
Mailing Address - Country:US
Mailing Address - Phone:704-930-3687
Mailing Address - Fax:
Practice Address - Street 1:3461 US HIGHWAY 601 S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0490
Practice Address - Country:US
Practice Address - Phone:704-930-3687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental