Dr. Shane Thomas Clark
Endodontist
2800 Coors Blvd Nw
Albuquerque
, New Mexico 87120-1204
Dr. Shane Thomas Clark
Endodontist
2800 Coors Blvd Nw
Albuquerque
, New Mexico 87120-1204
(512) 689-8382
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About
Features
Specialties
- Endodontist
Languages spoken
- English
Location
First Address
- Dr. Shane Thomas Clark
- 8400 Oakland Ave Ne
- Albuquerque, NM
- Zip : 87122-2721
- Phone : (512) 689-8382
Second Address
- Dr. Shane Thomas Clark
- 2800 Coors Blvd Nw
- Albuquerque, NM
- Zip : 87120-1204
- Phone : (505) 352-1166
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223E0200X | Endodontist | DD4100 | NM |
National Provider Identifier
| NPI | 1003220203 |
|---|---|
| Provider Name | Dr. Shane Thomas Clark |
| First Address | Albuquerque, NM 87122-2721 |
| Second Address | Albuquerque, NM 87120-1204 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 16/06/2014 |
| Last Update Date | 26/09/2015 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.