Individual
MR. TAYLOR COLEMAN CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6019 N EAGLE RD, BOISE, ID 83713
(208) 938-8228
(208) 938-2442
Mailing address
4400 N TEMPEST WAY, MERIDIAN, ID 83642
(208) 846-9226
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3624
ID
Other
Enumeration date
05/12/2006
Last updated
07/08/2007
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