Provider Demographics
NPI:1831215730
Name:CLARK, WILLIAM E (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:CLARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5777 N FRESNO ST
Mailing Address - Street 2:STE 110
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6065
Mailing Address - Country:US
Mailing Address - Phone:559-435-3111
Mailing Address - Fax:559-435-9337
Practice Address - Street 1:5777 N FRESNO ST
Practice Address - Street 2:STE 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6065
Practice Address - Country:US
Practice Address - Phone:559-435-3111
Practice Address - Fax:559-435-9337
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice