# MICHAEL E CLARKE DDSMS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Michael E. Clarke DDSMS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073644068
- **Authorized official:** DR. MICHAEL ELLSWORTH CLARKE D.D.S.,M. S. (OWNER)
- **Authorized official phone:** (808) 242-0077

## Contact information

- **Practice address:** 24 N CHURCH ST, SUITE 206, WAILUKU, HI 96793-1680
- **Practice address phone:** (808) 242-0077
- **Practice address fax:** (808) 243-8007
- **Mailing address:** 24 N CHURCH ST, SUITE 206, WAILUKU, HI 96793-1680
- **Mailing address phone:** (808) 242-0077
- **Mailing address fax:** (808) 243-8007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | HI | Yes |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00C0059976 | HAWAII MEDICAL SERVICE AS | HI |
| 01 | — | 1439 | HAWAII DENTAL SERVICE | HI |
| 05 | — | 526220-01 | — | HI |