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General NPI Number Information
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NPI Number | 1255281069
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Entity Type | Individual
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Provider Name | DAVID CLARK MASDEA JR.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2026
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Last Update Date | 01/31/2026
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Provider Practice Location Address
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Address Line | 834 3RD AVE N APT 2
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City | NEW ROCKFORD
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State | ND
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Zip | 58356-1508
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Country | US
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Telephone | 701-515-1062
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Fax | 701-515-1062
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Provider Business Mailing Address
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Address Line | 616 2ND AVE S
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City | NEW ROCKFORD
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State | ND
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Zip | 58356-1620
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Country | US
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Telephone |
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Fax |
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number | MAS91-4910
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License Number State | ND
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