Individual
DR. SHANE THOMAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2800 COORS BLVD NW, ALBUQUERQUE, NM 87120-1204
(505) 352-1166
Mailing address
8400 OAKLAND AVE NE, ALBUQUERQUE, NM 87122-2721
(512) 689-8382
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DD4100
NM
Other
Enumeration date
06/16/2014
Last updated
09/26/2015
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