Individual
DR. CHAMP CLARK TODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
412 CLARK ST, CANTON, MO 63435
(573) 288-5833
Mailing address
412 CLARK ST, CANTON, MO 63435
(573) 288-5833
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
013529
MO
Other
Enumeration date
12/14/2007
Last updated
12/14/2007
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