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Individual
DR. MICHAEL ELLSWORTH CLARKE
Active
Individual
DR. MICHAEL ELLSWORTH CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DT1439
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1439
HDS
HI
05
—
52622001
—
HI
01
—
B059978
HMSA
—
Enumeration date
03/30/2006
Last updated
07/08/2007
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