Individual
DR. JOEL R. CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1925 S SOSSAMAN RD, 211, MESA, AZ 85209-4275
(480) 503-3764
(480) 380-0336
Mailing address
1925 S SOSSAMAN RD, 211, MESA, AZ 85209-4275
(480) 503-3764
(480) 380-0336
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5179
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
713546
—
AZ
Enumeration date
02/16/2006
Last updated
07/08/2007
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