Michael Andrew Clarke, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1403 Issued in HI

Practice address

31 E Lanikaula St
Suite B
Hilo, HI 96720-4362

Phone

(808) 969-3830

Fax

(808) 969-1189

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619065133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 E LANIKAULA ST",
            "address_2": "SUITE B",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967204362",
            "telephone_number": "808-969-3830",
            "fax_number": "808-969-1189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 E LANIKAULA ST",
            "address_2": "SUITE B",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967204362",
            "telephone_number": "808-969-3830",
            "fax_number": "808-969-1189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "MICHAEL",
        "middle_name": "ANDREW",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "1403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02278001",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Emerson Chun, PT, DPT, TPS
• Ashley S Chung
• Haylee S Chung, APRN
• Anita Ciarleglio, PH.D. RPH.
• Clarence D Harkness DPM
• Amanda Rose Clausen
• Shannon Clavere
• Marinel Aguinaldo Clemente, BSN, RN
• Clinical Pharmacy Consultants
• Clinical Pharmacy Consultants

• General Practice Dentistry in Hilo, HI
• Providers in Hilo, HI by specialty
• General Practice Dentistry in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.