Provider Demographics
NPI:1497860118
Name:CLARKE, CRAIG M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
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 1:26615 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1968
Mailing Address - Country:US
Mailing Address - Phone:281-296-8600
Mailing Address - Fax:281-296-9509
Practice Address - Street 1:955 DAIRY ASHFORD ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5310
Practice Address - Country:US
Practice Address - Phone:281-531-7000
Practice Address - Fax:281-531-7023
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152800203Medicaid
TX152800205Medicaid
TX152800204Medicaid
TX152800206Medicaid
TX152800201Medicaid