Provider Demographics
NPI:1205059441
Name:CLARKE & FARMER DDS LTD
Entity type:Organization
Organization Name:CLARKE & FARMER DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-296-8043
Mailing Address - Street 1:1227 CEDARS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4800
Mailing Address - Country:US
Mailing Address - Phone:434-296-8043
Mailing Address - Fax:434-296-1286
Practice Address - Street 1:1227 CEDARS CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4800
Practice Address - Country:US
Practice Address - Phone:434-296-8043
Practice Address - Fax:434-296-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004067122300000X
VA0401005608122300000X
VA0401007444122300000X
VA0401411048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679540504Medicare UPIN
VA1457328387Medicare UPIN
VA1306813233Medicare UPIN
VA1033283213Medicare UPIN