Provider Demographics
NPI:1205923083
Name:CLARKE, PAUL JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
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 1:12802 VALLEY VIEW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845
Mailing Address - Country:US
Mailing Address - Phone:714-895-3955
Mailing Address - Fax:714-897-2024
Practice Address - Street 1:12802 VALLEY VIEW
Practice Address - Street 2:SUITE 2
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845
Practice Address - Country:US
Practice Address - Phone:714-895-3955
Practice Address - Fax:714-897-2024
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist