Individual
DR. CHARLIE E CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
15264 W BROOKSIDE LN, SURPRISE, AZ 85374-3989
(623) 474-3975
(623) 474-3198
Mailing address
15264 W BROOKSIDE LN, SURPRISE, AZ 85374-3989
(623) 474-3975
(623) 474-3198
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6303-15
WI
122300000X
Dentist
Primary
D7793
AZ
Other
Enumeration date
08/11/2008
Last updated
08/04/2009
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