Provider Demographics
NPI:1891756896
Name:CLARK, PAUL K (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:K
Last Name:CLARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:380 E 1500 S
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3940
Mailing Address - Country:US
Mailing Address - Phone:435-657-2105
Mailing Address - Fax:801-665-1414
Practice Address - Street 1:380 E 1500 S
Practice Address - Street 2:SUITE 205
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3940
Practice Address - Country:US
Practice Address - Phone:435-657-2105
Practice Address - Fax:801-665-1414
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6255201-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice