Individual
DAVID M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
801 S PAULINA ST, M/C 621, ROOM 301, CHICAGO, IL 60612-7210
(312) 996-1036
Mailing address
801 S PAULINA ST, M/C 621, ROOM 301, CHICAGO, IL 60612-7210
(312) 996-1036
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019026683
—
IL
Enumeration date
03/28/2008
Last updated
03/27/2012
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