Individual
DR. CHARLES LARRY CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
2415 GILLIONVILLE RD, ALBANY, GA 31707-3022
(229) 432-6751
(229) 432-5918
Mailing address
2415 GILLIONVILLE RD, ALBANY, GA 31707-3022
(229) 432-6751
(229) 432-5918
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013577
GA
Other
Enumeration date
10/21/2008
Last updated
10/21/2008
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