Individual
DR. LANCE D. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1698 RIO BRAVO BLVD SW, ALBUQUERQUE, NM 87105-6027
(505) 247-2717
Mailing address
1698 RIO BRAVO BLVD SW, ALBUQUERQUE, NM 87105-6027
(505) 247-2717
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1206
WY
122300000X
Dentist
Primary
DD3584
NM
Other
Enumeration date
12/08/2008
Last updated
01/23/2012
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