Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 10095 | TN |
Y | 1223D0001X | Dental Public Health | 180497 | AK |
NPI | 1427433119 |
---|---|
Provider Name | Dr. Christopher Clark |
First Address | Murfreesboro, TN 37130-0721 |
Second Address | Barrow, AK 99723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2015 |
Last Update Date | 08/10/2021 |