Individual
DR. MICHELLE HIROMI CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2441 21 ST., FORT CAMPBELL, KY 42223
(270) 798-8751
Mailing address
2441 21 ST., FORT CAMPBELL, KY 42223
(270) 798-8751
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D009580
AZ
Other
Enumeration date
09/12/2008
Last updated
01/14/2020
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