Individual
DR. PAUL KENNETH CLARK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D, M.D.
Contact information
Practice address
1502 LOCUST ST N STE 103, TWIN FALLS, ID 83301-6375
(208) 831-2900
Mailing address
1502 LOCUST ST N STE 103, TWIN FALLS, ID 83301-6375
(208) 831-2900
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7829973-9922
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D-5108-OS
ID
Other
Enumeration date
06/09/2010
Last updated
11/15/2022
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