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General NPI Number Information
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NPI Number | 1699443192
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Entity Type | Individual
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Provider Name | ZANE MATTHEW CLARK-GOLD DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 11601 MINNETONKA MILLS RD STE F40
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City | HOPKINS
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State | MN
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Zip | 55305-5189
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Country | US
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Telephone | 952-935-8420
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Fax |
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Provider Business Mailing Address
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Address Line | 2949 4TH ST SE UNIT 128
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-3883
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Country | US
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Telephone | 253-302-2106
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | R812
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License Number State | MN
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