Clarke, Michael Ellsworth

Clarke, Michael Ellsworth is an individual health care provider with primary practice located at 24 N Church St #206, Wailuku HI 96795. He recently has only one registered license in Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery, which is considered as his primary health care specialty. Clarke, Michael Ellsworth can be contacted via phone (808) 242-0077.

Contact Information

Primary practice address
24 N Church St #206 Wailuku HI 96795
Phone: (808) 242-0077
Fax: (808) 243-8007
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X DT1439 Hawaii

Profile Details

NPI number 1316908296
LBN Legal business name Clarke, Michael Ellsworth
Credentials DDS MS
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 30th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316908296 NPPES
Hawaii Other 1439 HDS
Hawaii MEDICAID 52622001 HDS
Hawaii Other B059978 HDS

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