Provider Demographics
NPI:1881767093
Name:PICK, CLARICE K (DDS)
Entity type:Individual
Prefix:DR
First Name:CLARICE
Middle Name:K
Last Name:PICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 SIRINGO RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5709
Mailing Address - Country:US
Mailing Address - Phone:505-982-0094
Mailing Address - Fax:505-982-9993
Practice Address - Street 1:125 SIRINGO RD STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5709
Practice Address - Country:US
Practice Address - Phone:505-982-0094
Practice Address - Fax:505-982-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM16071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM89433Medicaid