Organization
FOUR PEAKS FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT CLARK III DDS (DOCTOR)
(480) 994-9485
Entity
Organization
Contact information
Practice address
3666 N MILLER RD, 109, SCOTTSDALE, AZ 85251-4599
(480) 994-9485
(480) 481-3800
Mailing address
3666 N MILLER RD, 109, SCOTTSDALE, AZ 85251-4599
(480) 994-9485
(480) 481-3800
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
5498
AZ
261QD0000X
Dental Clinic/Center
Primary
6575
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
619934
—
AZ
05
—
955940
—
AZ
Enumeration date
08/13/2007
Last updated
08/13/2007
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