Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 44677 | CA |
NPI | 1114930724 |
---|---|
Provider Name | Clarke V. Filippi |
First Address | Modesto, CA 95350-1500 |
Second Address | Modesto, CA 95350-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |