Provider Demographics
NPI:1972945178
Name:CLARK, GAIL JOAN NICOLE BAKER (BSBA, RDH, MS)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:JOAN NICOLE BAKER
Last Name:CLARK
Suffix:
Gender:F
Credentials:BSBA, RDH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-3119
Mailing Address - Country:US
Mailing Address - Phone:717-517-1257
Mailing Address - Fax:
Practice Address - Street 1:5034 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-3119
Practice Address - Country:US
Practice Address - Phone:717-517-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101177124Q00000X
PADH070530124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18849006OtherNATIONAL INSURANCE PRODUCER (NPN)
PA858136OtherINSURANCE PRODUCER
NV101177OtherDENTAL HYGIENE & LOCAL ANESTHESIA
PADHA000615OtherDENTAL HYGIENE ANESTHESIA
PADH070530OtherDENTAL HYGIENE