KENNETH C. CLARK DDSMS NPI 1639568603

NPI Information

NPI: 1639568603
Provider Name: KENNETH C. CLARK DDS,MS
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
2524 HILLSIDE HEIGHTS DR
GREEN BAY, WI
ZIP 54311
Phone: (920) 246-6118
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KENNETH C. CLARK DDS,MS is a dental clinic center in Green Bay, WI. KENNETH C. CLARK DDS,MS NPI is 1639568603. The provider is registered as an organization entity type.

The provider's business location address is:

2524 HILLSIDE HEIGHTS DR
GREEN BAY, WI
ZIP 54311-777
Phone: (920) 246-6118

The provider's authorized official is Kenneth Charles Clark .
The authorized official title is Endodontist and has the following contact phone number (920) 246-6118.

The enumeration date for this NPI number is 1/14/2015 and was last updated on 1/14/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	3707-15	WISCONSIN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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