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General NPI Number Information
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NPI Number | 1952893026
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Entity Type | Individual
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Provider Name | DR. DEVIN CLARK
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Gender | Male
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 617 CEMETERY RD
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City | WINLOCK
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State | WA
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Zip | 98596-9303
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Country | US
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Telephone | 360-785-4755
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Fax |
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Provider Business Mailing Address
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Address Line | 3 E SHORE DR
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City | ASHEVILLE
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State | NC
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Zip | 28805-2201
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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 | 11032
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License Number State | NC
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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 | DE61007637
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License Number State | WA
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