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Dominique Clark
NPI 1265678502 · on the registry since 2008 · sole proprietor
Practice
- Address
- 12201 Wallace Landing Ct
Upper Marlboro, MD 20772 - Phone
- (240) 417-9810
Registry record
- Primary taxonomy
- 235Z00000X
235Z00000X
- Also registered as
- 235Z00000X
235Z00000X - Licence states on file
- IL, IN, MD
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2018-08-03
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 Maryland