Individual
DR. ROBERT WALLACE CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
11169 W ALABAMA AVE, YOUNGTOWN, AZ 85363-1228
(623) 933-2971
(623) 972-4420
Mailing address
11169 W ALABAMA AVE, YOUNGTOWN, AZ 85363-1228
(623) 933-2971
(623) 972-4420
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
AZ2129
AZ
Other
Enumeration date
12/06/2006
Last updated
07/08/2007
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