Most Relevant Information
Provider Data
| NPI Number: | 1003220203 |
| Provider Name: | SHANE THOMAS CLARK DMD |
| Entity Type: | Individual |
| Taxonomy Code: | 1223E0200X |
| Specialty: | Dentist |
| License Number: | DD4100 |
Most Important Dates
| Enumeration Date: | 06/16/2014 |
| Last Updated: | 09/26/2015 |
Provider Practice Location
2800 COORS BLVD NW
ALBUQUERQUE
NM
871201204
Practice Location Phone/Fax
| Phone: | 5053521166 |
| Fax: |
Provider Mailing Location
8400 OAKLAND AVE NE
ALBUQUERQUE
NM
871222721
Provider Mailing Phone/Fax
| Phone: | 5126898382 |
| Fax: |