Provider Demographics
NPI:1568774511
Name:CLARKSON, TODD C (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:C
Last Name:CLARKSON
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 1:3121 BILL TUCK HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-6385
Mailing Address - Country:US
Mailing Address - Phone:434-575-1505
Mailing Address - Fax:434-575-1505
Practice Address - Street 1:3121 BILL TUCK HWY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-6385
Practice Address - Country:US
Practice Address - Phone:434-575-1505
Practice Address - Fax:434-575-1505
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014132191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice