Provider Demographics
NPI:1952416273
Name:CLARK, ROBERT FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FREDERICK
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 1:7555 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3516
Mailing Address - Country:US
Mailing Address - Phone:315-457-0620
Mailing Address - Fax:315-457-0656
Practice Address - Street 1:7555 MORGAN RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3516
Practice Address - Country:US
Practice Address - Phone:315-457-0620
Practice Address - Fax:315-457-0656
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist