Provider Demographics
NPI:1205932480
Name:CLARKE, TRISCHA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:TRISCHA
Middle Name:ANN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TRISCHA
Other - Middle Name:ANN
Other - Last Name:LECHTENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:924 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7696
Mailing Address - Country:US
Mailing Address - Phone:405-799-5675
Mailing Address - Fax:
Practice Address - Street 1:940 NE 13TH ST
Practice Address - Street 2:RM 2102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5008
Practice Address - Country:US
Practice Address - Phone:405-271-4750
Practice Address - Fax:405-271-4055
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice