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General NPI Number Information
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NPI Number | 1003086224
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Entity Type | Individual
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Provider Name | ADAM M CLARK DMD
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Gender | Male
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 1416 ASHLEY RIVER RD ATLANTIC AESTHETICS
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City | CHARLESTON
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State | SC
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Zip | 29407-5306
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Country | US
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Telephone | 843-769-0488
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Fax | 843-769-0428
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Provider Business Mailing Address
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Address Line | 1416 ASHLEY RIVER RD ATLANTIC AESTHETICS
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City | CHARLESTON
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State | SC
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Zip | 29407-5306
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Country | US
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Telephone | 843-769-0488
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Fax | 843-769-0428
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 3728545
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License Number State | SC
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