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Organization
KENNETH C. CLARK DDS,MS
Active
Organization
KENNETH C. CLARK DDS,MS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH CHARLES CLARK D.D.S., M.S. (ENDODONTIST)
(920) 246-6118
Entity
Organization
Contact information
Practice address
2524 HILLSIDE HEIGHTS DR, GREEN BAY, WI 54311-6777
(920) 246-6118
Mailing address
2524 HILLSIDE HEIGHTS DR, GREEN BAY, WI 54311-6777
(920) 246-6118
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3707-15
WI
Other
Enumeration date
01/14/2015
Last updated
01/14/2015
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