Individual
KELLY R CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2204 E 29TH AVE, STE. 208, SPOKANE, WA 99203-3961
(509) 535-9515
Mailing address
2204 E 29TH AVE, STE. 208, SPOKANE, WA 99203-3961
(509) 535-9515
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D8421
OR
1223G0001X
General Practice Dentistry
Primary
DE00010199
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
233086
—
OR
Enumeration date
11/23/2005
Last updated
07/18/2008
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