Provider Demographics
NPI:1457524175
Name:CRESSMAN, CLARK EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:EUGENE
Last Name:CRESSMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 ANTHEM VILLAGE DR STE E-578
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5505
Mailing Address - Country:US
Mailing Address - Phone:760-578-4327
Mailing Address - Fax:
Practice Address - Street 1:669 N STEPHANIE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2634
Practice Address - Country:US
Practice Address - Phone:702-309-9001
Practice Address - Fax:702-309-9016
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386821223G0001X
NV49381223G0001X, 122300000X
AZD5620122300000X
NV4938T122300000X
CA44301122300000X
TN118841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist