Provider Demographics
NPI:1780778050
Name:CLARK, DENNIS EUGENE (DDS)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:EUGENE
Last Name:CLARK
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 1:2121 LEEDS ROAD
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-9651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 LEEDS RD
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-9651
Practice Address - Country:US
Practice Address - Phone:209-383-5561
Practice Address - Fax:209-383-5561
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360731223G0001X
WADE000067801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice