Provider Demographics
NPI:1477883015
Name:DONALD E. CLARKE, D.D.S., INC.
Entity type:Organization
Organization Name:DONALD E. CLARKE, D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-487-0117
Mailing Address - Street 1:3485 W SHAW AVE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3212
Mailing Address - Country:US
Mailing Address - Phone:559-276-7995
Mailing Address - Fax:559-276-7997
Practice Address - Street 1:3485 W SHAW AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3212
Practice Address - Country:US
Practice Address - Phone:559-276-7995
Practice Address - Fax:559-276-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental