| NPI | 1447638218 |
|---|---|
| Doing Business As | CLARK FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | CANDICE ELLA CLARK Owner/Vice President 505-325-7121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM 2673) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2015-05-13 |