Criston C. Clark, D.M.D. Valid NPI

Individual provider · Dentist · Ringgold, GA

NPI

1740420629

Type

Individual (Type 1)

Primary specialty

Dentist

Specialty group

Dental Providers

Taxonomy code

122300000X

License number

011280 (GA)

Sex

Male

Sole proprietor

No

Enumerated

2009-03-04

Last updated

2009-03-04