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Individual

MS. GAIL JOAN NICOLE BAKER CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BSBA, RDH, MS

Contact information

Practice address
5034 ROYAL AVE, HARRISBURG, PA 17109-3119
(717) 517-1257
Mailing address
5034 ROYAL AVE, HARRISBURG, PA 17109-3119
(717) 517-1257

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
101177
NV
124Q00000X
Dental Hygienist
Primary
DH070530
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
101177
DENTAL HYGIENE & LOCAL ANESTHESIA
NV
01
18849006
NATIONAL INSURANCE PRODUCER (NPN)
PA
01
858136
INSURANCE PRODUCER
PA
01
DH070530
DENTAL HYGIENE
PA
01
DHA000615
DENTAL HYGIENE ANESTHESIA
PA
Enumeration date
07/29/2013
Last updated
08/17/2021
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