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1417103482
CHARLIE E CLARK
SURPRISE, AZ
NPI
1417103482
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
122300000X Dentist
(Licence: AZ D7793)
Additional Taxonomies
122300000X Dentist
(Licence: WI 6303-15)
Enumeration Date
2008-08-11
Last Update Date
2009-08-04
Business Address
Dr. CHARLIE E CLARK DMD
15264 W BROOKSIDE LN
SURPRISE, AZ 85374-3989
Phone number: 623-474-3975
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Mailing Address
Dr. CHARLIE E CLARK DMD
15264 W BROOKSIDE LN
SURPRISE, AZ 85374-3989
Phone number: 623-474-3975
Copy
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