Individual
DR. GUY CHARLES CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S. PA
Contact information
Practice address
3613 NEW MEXICO HIGHWAY 528, SUITE G, ALBUQUERQUE, NM 87114
(505) 898-8011
(505) 890-7423
Mailing address
3613 NEW MEXICO HIGHWAY 528, SUITE G, ALBUQUERQUE, NM 87114
(505) 898-8011
(505) 890-7423
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD1139
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141339
UNITED CONCORDIA INSURANC
—
Enumeration date
08/11/2006
Last updated
07/08/2007
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