Individual
CARLY RENE' CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH, EP
Contact information
Practice address
3324 N ARLINGTON PL, PORTLAND, OR 97217-7204
(503) 887-5923
Mailing address
3324 N ARLINGTON PL, PORTLAND, OR 97217-7204
(503) 887-5923
Taxonomy
Speciality
Code
Description
License number
State
125K00000X
Advanced Practice Dental Therapist
Primary
H5380
OR
Other
Enumeration date
05/08/2013
Last updated
05/08/2013
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