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General NPI Number Information
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NPI Number | 1679745129
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Entity Type | Individual
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Provider Name | MR. HARRY M CLARK III
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Gender | Male
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 519 STATE ROUTE 67
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City | MALTA
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State | NY
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Zip | 12020-4334
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Country | US
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Telephone | 518-899-7121
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Fax |
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Provider Business Mailing Address
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Address Line | 142 COUNTY ROUTE 70
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City | GREENWICH
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State | NY
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Zip | 12834-6302
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | NY
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