Individual
TAYLOR CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3 ROAD 6523, KIRTLAND, NM 87417-9452
(505) 598-6800
Mailing address
3 ROAD 6523, KIRTLAND, NM 87417-9452
(505) 598-6800
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3385
NM
122300000X
Dentist
Primary
6577
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
947963
—
AZ
Enumeration date
07/31/2006
Last updated
08/09/2011
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