Individual
ROBERTA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDHAP, MS
Contact information
Practice address
8403 CHRISTOPHER RIDGE TER, SAN DIEGO, CA 92127-6143
(858) 367-8320
Mailing address
8403 CHRISTOPHER RIDGE TER, SAN DIEGO, CA 92127-6143
(858) 367-8320
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
RDH 15432
CA
124Q00000X
Dental Hygienist
Primary
RDHAP 522
CA
Other
Enumeration date
01/17/2015
Last updated
05/31/2015
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