Individual
MS. VIVIAN L CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
BDC NORTH ISLAND, BOX 357037, SAN DIEGO, CA 92135-7037
(619) 545-6398
Mailing address
795 RIVER ROCK RD, CHULA VISTA, CA 91914-2431
(619) 397-5705
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
9175
CA
Other
Enumeration date
02/21/2006
Last updated
07/08/2007
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