Individual
DR. THEODORE GLENN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3165 MAPLEWOOD AVENUE, WINSTON-SALEM, NC 27103
(336) 765-8358
(336) 774-1063
Mailing address
3165 MAPLEWOOD AVENUE, WINSTON-SALEM, NC 27103
(336) 765-8358
(336) 774-1063
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6127
NC
Other
Enumeration date
09/26/2006
Last updated
07/08/2007
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