Organization
MICHAEL E CLARKE DDSMS INC
Active
Other names
Michael E. Clarke DDSMS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ELLSWORTH CLARKE D.D.S.,M. S. (OWNER)
(808) 242-0077
Entity
Organization
Contact information
Practice address
24 N CHURCH ST, SUITE 206, WAILUKU, HI 96793-1680
(808) 242-0077
(808) 243-8007
Mailing address
24 N CHURCH ST, SUITE 206, WAILUKU, HI 96793-1680
(808) 242-0077
(808) 243-8007
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C0059976
HAWAII MEDICAL SERVICE AS
HI
01
—
1439
HAWAII DENTAL SERVICE
HI
05
—
526220-01
—
HI
Enumeration date
03/08/2007
Last updated
07/21/2022
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