Provider Demographics
NPI:1699061374
Name:CLARKE, JONATHAN ARTHUR (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ARTHUR
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 1:2080 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8051
Mailing Address - Country:US
Mailing Address - Phone:405-281-5800
Mailing Address - Fax:405-703-9160
Practice Address - Street 1:4420 W I 40 SERVICE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1896
Practice Address - Country:US
Practice Address - Phone:405-948-8779
Practice Address - Fax:405-948-8773
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK62761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice