Provider Demographics
NPI:1851521116
Name:CLARKE, PAUL S IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:CLARKE
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 US HIGHWAY 601 S
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0490
Mailing Address - Country:US
Mailing Address - Phone:980-777-8088
Mailing Address - Fax:980-777-8069
Practice Address - Street 1:3475 US HIGHWAY 601 S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0490
Practice Address - Country:US
Practice Address - Phone:980-777-8088
Practice Address - Fax:980-777-8069
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist