Individual
DR. MICHAEL ELLSWORTH CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
24 N CHURCH ST, #206, WAILUKU, HI 96795
(808) 242-0077
(808) 243-8007
Mailing address
24 N CHURCH ST, #206, WAILUKU, HI 96795
(808) 242-0077
(808) 243-8007
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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