Individual
BRETT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6317 ODANA RD, MADISON, WI 53719-1107
(608) 274-1911
(608) 274-1858
Mailing address
6317 ODANA RD, MADISON, WI 53719-1107
(608) 274-1911
(608) 274-1858
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5014-015
WI
Other
Enumeration date
10/27/2006
Last updated
02/11/2013
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