Clark, Joel R.

Clark, Joel R. is an individual health care provider with primary practice located at 1925 S Sossaman Rd 211, Mesa AZ 85209-4275. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Clark, Joel R. can be contacted via phone (480) 503-3764.

Contact Information

Primary practice address
1925 S Sossaman Rd 211 Mesa AZ 85209-4275
Phone: (480) 503-3764
Fax: (480) 380-0336
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X 5179 Arizona

Profile Details

NPI number 1790759439
LBN Legal business name Clark, Joel R.
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 16th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790759439 NPPES
Arizona MEDICAID 713546

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