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General NPI Number Information
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NPI Number | 1063612224
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Entity Type | Organization
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Legal Business Name | HEATHER M. CLARK D.M.D PC
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 2311 NEW RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1442
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Country | US
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Telephone | 609-646-2501
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Fax | 609-646-0151
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Provider Business Mailing Address
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Address Line | 2311 NEW RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1442
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Country | US
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Telephone | 609-646-2501
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Fax | 609-646-0151
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Authorized Official
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Title or Position | ASSISTANT OFFICE MANAGER
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Name | JENNY HERNANDEZ
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Credential |
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Telephone | 609-646-2501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI20003
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License Number State | NJ
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