CHARLIE E CLARK

SURPRISE, AZ
NPI1417103482
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy122300000X Dentist
(Licence: AZ  D7793)
Additional Taxonomies122300000X Dentist
(Licence: WI  6303-15)
Enumeration Date2008-08-11
Last Update Date2009-08-04
Business Address
DR. CHARLIE E CLARK DMD
15264 W BROOKSIDE LN
SURPRISE, AZ 85374-3989
Phone number: 623-474-3975
Mailing Address
DR. CHARLIE E CLARK DMD
15264 W BROOKSIDE LN
SURPRISE, AZ 85374-3989
Phone number: 623-474-3975
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