Provider Demographics
NPI:1689745879
Name:C. W. CLARKE DDS PC
Entity Type:Organization
Organization Name:C. W. CLARKE DDS PC
Other - Org Name:ADVANCED ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-894-5600
Mailing Address - Street 1:4121 UNION RD
Mailing Address - Street 2:STE 215
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1070
Mailing Address - Country:US
Mailing Address - Phone:314-894-5600
Mailing Address - Fax:
Practice Address - Street 1:4121 UNION RD
Practice Address - Street 2:STE 215
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1070
Practice Address - Country:US
Practice Address - Phone:314-894-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE015629261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental