Provider Demographics
NPI:1457328387
Name:CLARKE, STEPHEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
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 1:1227 CEDARS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4800
Mailing Address - Country:US
Mailing Address - Phone:434-296-8043
Mailing Address - Fax:
Practice Address - Street 1:1227 CEDARS CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4800
Practice Address - Country:US
Practice Address - Phone:434-296-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010040671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA892536OtherUNITED CONCORDIA GROUP #
VA031171OtherANTHEM PROVIDER NUMBER