Provider Demographics
NPI:1932497203
Name:CLARKE, ADAM GEORGE (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GEORGE
Last Name:CLARKE
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 1:1115 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9549
Mailing Address - Country:US
Mailing Address - Phone:435-757-3933
Mailing Address - Fax:
Practice Address - Street 1:1747 HERITAGE LN STE A1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8531
Practice Address - Country:US
Practice Address - Phone:801-525-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113329451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice