Provider Demographics
NPI:1942270640
Name:CLARKE, PAMELA ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ANN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:BRENNAN-CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:27 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1101
Mailing Address - Country:US
Mailing Address - Phone:412-788-6684
Mailing Address - Fax:412-788-6844
Practice Address - Street 1:27 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1101
Practice Address - Country:US
Practice Address - Phone:412-788-6684
Practice Address - Fax:412-788-6844
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025668L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist