NPI 1003220203
Shane Thomas Clark, DMD
Practice location
- Address
- 2800 Coors Blvd NW, Albuquerque, NM 87120-1204
- Phone
- (505) 352-1166
- Mailing address
- 8400 Oakland Ave NE, Albuquerque, NM 87122-2721
Registered specialties
Endodontics
Primary
Registry record
- NPI
- 1003220203
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 16 Jun 2014
- Record last updated
- 26 Sep 2015
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.