Organization
CHARLES M CLARK DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MILTON CLARK DMD (PRESIDENT)
(843) 623-2053
Entity
Organization
Contact information
Practice address
918 HOLLY ST, CHESTERFIELD, SC 29709
(843) 623-2053
Mailing address
PO BOX 70, CHESTERFIELD, SC 29709
(843) 623-2053
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1921
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z19212
—
SC
Enumeration date
08/04/2006
Last updated
06/16/2008
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