Clark, Michael

Clark, Michael is an individual health care provider with primary practice located at 11 Norwich St Suite # 3, Worcester MA 01608-2421. He recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as his primary health care specialty. Clark, Michael can be contacted via phone (508) 755-1119.

Contact Information

Primary practice address
11 Norwich St Suite # 3 Worcester MA 01608-2421
Phone: (508) 755-1119
Fax: (508) 755-1172
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Hygienist 124Q00000X DH10401 Massachusetts

Profile Details

NPI number 1477694123
LBN Legal business name Clark, Michael
Credentials Registered Dental Hygienist (RDH)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 8th, 2007
Last updated Dec 21st, 2011 - about 14 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 1477694123 NPPES
Massachusetts MEDICAID 1301071

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