Organization
CLARK ENDODONTICS LLC
Active
Other names
Advanced Endodontics
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE T CLARK DMD (DOCTOR/OWNER)
(505) 797-1212
Entity
Organization
Contact information
Practice address
7520 MONTGOMERY BLVD NE BLDG E1, ALBUQUERQUE, NM 87109
(505) 797-1212
(505) 823-1831
Mailing address
7520 MONTGOMERY BLVD NE BLDG E1, ALBUQUERQUE, NM 87109-1554
(505) 797-1212
(505) 823-1831
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DD4100
NM
Other
Enumeration date
07/30/2018
Last updated
07/30/2018
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