Provider Demographics
NPI:1447294087
Name:CLARKE, JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2515
Mailing Address - Country:US
Mailing Address - Phone:203-269-1460
Mailing Address - Fax:
Practice Address - Street 1:727 BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4341
Practice Address - Country:US
Practice Address - Phone:203-235-1415
Practice Address - Fax:203-235-3328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice