Individual
DR. TIMOTHY PAUL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12392 PLEASANT AVE., BECKER, MN 55308-0098
(763) 261-5350
(763) 262-5351
Mailing address
PO BOX 98, 12392 PLEASANT AVE., BECKER, MN 55308-0098
(763) 261-5350
(763) 262-5351
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10140
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6B403CL
BCBS PROVIDER NUMBER
MN
Enumeration date
10/26/2006
Last updated
07/08/2007
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