Provider Demographics
NPI:1598731036
Name:CLARKE, DENISE ELIZABETH (MSED DMD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ELIZABETH
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MSED DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6421
Mailing Address - Country:US
Mailing Address - Phone:360-457-9470
Mailing Address - Fax:360-457-6966
Practice Address - Street 1:902 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6421
Practice Address - Country:US
Practice Address - Phone:360-457-9470
Practice Address - Fax:360-457-6966
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA69461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU33077Medicare UPIN