MEDICARE: DR. DAVID P. CLARK DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	21978	CA

General Provider Information

NPI Number	:	1629344668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID P. CLARK DDS, MS

Provider Business Mailing Address
First Line	:	6177 N THESTA ST STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-8600
Country	:	US
Telephone Number	:	559-447-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	6177 N THESTA ST STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-8600
Country	:	US
Telephone Number	:	559-447-5050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	07/29/2016

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