Provider Demographics
NPI:1801282322
Name:MICHAEL A. CLARKE, D.D.S
Entity type:Organization
Organization Name:MICHAEL A. CLARKE, D.D.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-969-3830
Mailing Address - Street 1:31 E LANIKAULA ST STE B
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4362
Mailing Address - Country:US
Mailing Address - Phone:808-969-3830
Mailing Address - Fax:808-969-1189
Practice Address - Street 1:31 E LANIKAULA ST STE B
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4362
Practice Address - Country:US
Practice Address - Phone:808-969-3830
Practice Address - Fax:808-969-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT1403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDT1403OtherDT-1403