Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 39247 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 39247 | CA |
N | 1223X0008X | Oral and Maxillofacial Radiology | 39247 | CA |
NPI | 1487740007 |
---|---|
Provider Name | Dr. William James Clark |
First Address | Oxnard, CA 93030-8210 |
Second Address | Oxnard, CA 93030-8210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 14/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U72953 | (02) | CA |