Provider Demographics
NPI:1952491334
Name:WHITE, CLARK C III (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:C
Last Name:WHITE
Suffix:III
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 1:6801 MAYFIELD RD
Mailing Address - Street 2:SUITE 548
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2210
Mailing Address - Country:US
Mailing Address - Phone:440-461-0994
Mailing Address - Fax:440-461-0935
Practice Address - Street 1:6801 MAYFIELD RD
Practice Address - Street 2:SUITE 548
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2210
Practice Address - Country:US
Practice Address - Phone:440-461-0994
Practice Address - Fax:440-461-0935
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH190091223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics