Individual
H. CLARK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2101 HILL AVE, SUPERIOR, WI 54880-5260
(715) 392-5161
(715) 392-7474
Mailing address
2101 HILL AVE, SUPERIOR, WI 54880-5260
(715) 392-5161
(715) 392-7474
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5751-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12
DENTAL
WI
Enumeration date
05/14/2015
Last updated
05/14/2015
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