Individual
DR. EARL I CLARKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
760 BROADWAY, WOODHULL MEDICAL & MENTAL HEALTH CENTER, BROOKLYN, NY 11206
(718) 963-8000
(718) 250-6431
Mailing address
760 BROADWAY DEPARTMENT OF MANAGED CARE ROOM 2B230, WOODHULL MEDICAL & MENTAL HEALTH CENTER, BROOKLYN, NY 11206
(718) 963-8000
(718) 630-3122
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
036255
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00759251
—
NY
01
—
4572181
AETNA
NY
01
—
P417983
OXFORD
NY
Enumeration date
07/14/2006
Last updated
09/17/2014
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