Provider Demographics
NPI:1881808475
Name:MARK S. CLOTH DDS, PC
Entity type:Organization
Organization Name:MARK S. CLOTH DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:CLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-975-3013
Mailing Address - Street 1:1912 RIVER INN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-6203
Mailing Address - Country:US
Mailing Address - Phone:434-975-3013
Mailing Address - Fax:
Practice Address - Street 1:500 N COALTER ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3401
Practice Address - Country:US
Practice Address - Phone:540-886-8331
Practice Address - Fax:540-886-8334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010058511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty