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General NPI Number Information
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NPI Number | 1568732048
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Entity Type | Organization
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Legal Business Name | BRADLEY P CLARK DDS INC
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Dates
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Enumeration Date | 12/30/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 450 SUTTER ST SUITE 2109
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-4206
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Country | US
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Telephone | 415-781-2674
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Fax |
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Provider Business Mailing Address
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Address Line | 450 SUTTER ST SUITE 2109
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-4206
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Country | US
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Telephone | 415-781-2674
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY P CLARK
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Credential | DDS
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Telephone | 416-781-2674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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