Provider Demographics
NPI:1003086224
Name:CLARK, ADAM M (DMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:M
Last Name:CLARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 ASHLEY RIVER RD
Mailing Address - Street 2:ATLANTIC AESTHETICS
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5306
Mailing Address - Country:US
Mailing Address - Phone:843-769-0488
Mailing Address - Fax:843-769-0428
Practice Address - Street 1:1416 ASHLEY RIVER RD
Practice Address - Street 2:ATLANTIC AESTHETICS
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5306
Practice Address - Country:US
Practice Address - Phone:843-769-0488
Practice Address - Fax:843-769-0428
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37285451223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics