Individual
MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDH
Contact information
Practice address
11 NORWICH ST, SUITE # 3, WORCESTER, MA 01608-2421
(508) 755-1119
(508) 755-1172
Mailing address
11 NORWICH ST, SUITE # 3, WORCESTER, MA 01608-2421
(508) 755-1119
(508) 755-1172
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH10401
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1301071
—
MA
Enumeration date
02/08/2007
Last updated
12/21/2011
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