Individual
CHAD MICHAEL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS, BS
Contact information
Practice address
604 MEADOWLARK LN, RIVERTON, WY 82501-2214
(307) 343-5676
Mailing address
PO BOX 966, THAYNE, WY 83127-0966
(307) 343-5676
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1606
WY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/18/2022
Last updated
11/11/2023
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