NPIMap

Organization Active NPI

Donald E. Clarke, D.D.S., Inc.

Doing business as Dental Source of California

  • General Practice Dentistry
  • Stockton, CA
National Provider Identifier
1073939617
Registry record updated Mar 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
33738 Issued in CA
Legal business name
DONALD E. CLARKE, D.D.S., INC.
Doing business as
Dental Source of California
Practice address
7616 Pacific Ave
Stockton, CA 95207-1952
Phone
(209) 952-1641
Fax
(209) 952-2856
NPI assigned
Mar 6, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Donald Clarke, D.D.S.
Title
President, Donald E. Clarke, D.D.S.
Phone
(916) 487-0117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 33738 CA Primary

Addresses

Primary practice location

7616 Pacific Ave
Stockton, CA 95207-1952

Mailing address

7616 Pacific Ave
Stockton, CA 95207-1952
Phone (209) 952-1641

Other names 1

  • Dental Source of California Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Source of California9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7616 Pacific Ave
Stockton, CA 95207
Phone (209) 952-1641

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394064000000",
    "number": "1073939617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7616 PACIFIC AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952071952",
            "telephone_number": "209-952-1641",
            "fax_number": "209-952-2856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7616 PACIFIC AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952071952",
            "telephone_number": "209-952-1641",
            "fax_number": "209-952-2856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DONALD E. CLARKE, D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-06",
        "last_updated": "2014-03-06",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT, DONALD E. CLARKE, D.D.S.",
        "authorized_official_telephone_number": "916-487-0117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "33738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Source of California",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.