Provider Demographics
NPI:1659507978
Name:MARK S. CLOTH, D.D.S., P.C.
Entity Type:Organization
Organization Name:MARK S. CLOTH, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-964-2464
Mailing Address - Street 1:190 ALBEMARLE SQ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-7403
Mailing Address - Country:US
Mailing Address - Phone:434-964-2464
Mailing Address - Fax:434-964-2465
Practice Address - Street 1:190 ALBEMARLE SQ
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-7403
Practice Address - Country:US
Practice Address - Phone:434-964-2464
Practice Address - Fax:434-964-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA58511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty