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General NPI Number Information
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NPI Number | 1619919685
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Entity Type | Individual
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Provider Name | DAVID MICHAEL CLARK D.M.D
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 799 NORTHERN BLVD
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City | SOUTH ABINGTON TOWNSHIP
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State | PA
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Zip | 18411-9087
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Country | US
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Telephone | 570-586-1700
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Fax | 570-586-1900
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Provider Business Mailing Address
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Address Line | 799 NORTHERN BLVD
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City | SOUTH ABINGTON TOWNSHIP
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State | PA
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Zip | 18411-9087
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Country | US
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Telephone | 570-586-1700
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Fax | 570-586-1900
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DA 026947 A
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS 026947 L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 046057-1
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License Number State | NY
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