Individual
DR. ANTHONY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4129 S MOONEY BLVD STE B, VISALIA, CA 93277-9147
(559) 732-1953
Mailing address
2159 BELLA OAKS DR, TULARE, CA 93274-7760
(559) 495-8085
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DDS102890
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DDS102890
CALIFORNIA DENTAL LICENSE
CA
Enumeration date
08/10/2018
Last updated
08/10/2018
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