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DR. ROBERT WALLACE CLARK D.D.S.

>> Dentist >> Dental Providers

Registrant NPI Number: 1558420638

Individual Registrant:
DR. ROBERT WALLACE CLARK D.D.S.
Gender: M
Sole Proprietor

Location and contact information for practice:
11169 W ALABAMA AVE  YOUNGTOWN, AZ 85363-1228 US
Tel: 623-933-2971  Fax: 623-972-4420

Contact information for business:
11169 W ALABAMA AVE  YOUNGTOWN, AZ 85363-1228 US
Tel: 623-933-2971  Fax: 623-972-4420

Registration Information:
NPI: 1558420638
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers
Dentist
AZAZ2129

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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