Organization
SUNRISE DENTAL GROUP PC
Active
Other names
Clark Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CANDICE ELLA CLARK DDS (OWNER/VICE PRESIDENT)
(505) 325-7121
Entity
Organization
Contact information
Practice address
141 W 20TH ST, FARMINGTON, NM 87401-3401
(505) 325-7121
Mailing address
141 W 20TH ST, FARMINGTON, NM 87401-3401
(505) 325-7121
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2673
NM
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
05/13/2015
Last updated
05/13/2015
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