Individual
STEPHEN B CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS,MS
Contact information
Practice address
701 N DUSTIN AVE, FARMINGTON, NM 87401-6101
(505) 327-4495
(505) 325-9125
Mailing address
701 N DUSTIN AVE, FARMINGTON, NM 87401-6101
(505) 327-4495
(505) 325-9125
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD871
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006258
—
NM
05
—
00081208
—
NM
Enumeration date
10/24/2005
Last updated
07/08/2007
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