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Contact Information

TAYLOR CLARK, DDS
3 ROAD 6523
KIRTLAND, NM87417-9452
 Phone: 505-598-6800
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for TAYLOR CLARK · (Male)

NPI Number 1336155571
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 07/31/2006
Last updated 08/09/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • AZ License # 6577
  • NM License # 3385
  • AZ Medicaid 947963
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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