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Search › Arizona › 122300000X

Charlie Clark, DMD

NPI 1417103482 · on the registry since 2008

Practice

Address
15264 W Brookside Ln
Surprise, AZ 85374
Phone
(623) 474-3975
Fax
(623) 474-3198
Organisation at this address
Kids Dental Surprise, Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
2

Registry record

Primary taxonomy
122300000X
122300000X
Also registered as
122300000X
Licence states on file
AZ, WI
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2009-08-04

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 Arizona