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General NPI Number Information
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NPI Number | 1699904003
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Entity Type | Individual
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Provider Name | BRIDGETE H CLARK DDS
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Gender | Female
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 6500 SOQUEL DRIVE
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City | APTOS
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State | CA
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Zip | 95003
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Country | US
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Telephone | 831-479-6472
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Fax | 831-477-5687
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Provider Business Mailing Address
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Address Line | PO BOX 1406
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City | CASTROVILLE
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State | CA
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Zip | 95012-1406
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Country | US
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Telephone | 831-479-6472
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Fax | 831-477-5687
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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 | 42987
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4771-15
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License Number State | WI
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