Individual
CLARK E MELSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4601 STOCKTON HILL RD., KINGMAN, AZ 86409-1759
(928) 757-3225
(928) 757-7477
Mailing address
4601 STOCKTON HILL RD, KINGMAN, AZ 86409-1756
(928) 757-3225
(928) 757-7477
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2714
AZ
Other
Enumeration date
06/06/2013
Last updated
06/06/2013
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