| Charles M Clark Dmd Pa | |
|
918 Holly St Chesterfield SC 29709 | |
| (843) 623-2053 | |
| Not Available |
| Full Name | Charles M Clark Dmd Pa |
|---|---|
| Speciality | Dentist |
| Location | 918 Holly St, Chesterfield, South Carolina |
| Authorized Official Name and Position | Charles Milton Clark (PRESIDENT) |
| Authorized Official Contact | 8436232053 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles M Clark Dmd Pa Po Box 70 Chesterfield SC 29709 Ph: (843) 623-2053 | Charles M Clark Dmd Pa 918 Holly St Chesterfield SC 29709 Ph: (843) 623-2053 |
| NPI Number | 1457369308 |
|---|---|
| Provider Enumeration Date | 08/04/2006 |
| Last Update Date | 06/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457369308 | NPI | - | NPPES |
| Z19212 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 1921 (South Carolina) | Primary |