Individual
DR. BRENT WAYNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
FLUGPLATZ ERBENHEIM 1040, WIESBADEN, NY 65205
(314) 590-1515
Mailing address
UNIT 33100 BOX LANDSTUHL, APO, AE 09180-3100
(314) 590-1515
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
14192587-9926
UT
Other
Enumeration date
08/17/2006
Last updated
07/10/2025
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