Charles Clark, MD

NPI 1124301106 · on the registry since 2011 · sole proprietor

Practice

Address: 2802 Lafayette Road Suite 13
Eagledale Health Center
Indianapolis, IN 46222
Phone: (317) 923-7510
Fax: (317) 923-7518
Organisation at this address: Indy West Smiles Youth Dentistry, Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 5

Registry record

Primary taxonomy: 207RE0101X
207RE0101X
Licence states on file: IN
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2011-09-26

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana