Clark, Glen Thomas
Clark, Glen Thomas is an individual health care provider with primary practice located at 925 W 34Th St Room #151, Los Angeles CA 90089-0641. He recently has 3 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Pathology, Dental Providers / Oral and Maxillofacial Surgery, Dental Providers / Dentist. Dental Providers / Dentist is his primary health care specialty. Clark, Glen Thomas can be contacted via phone (213) 740-7405.Contact Information
Primary practice address
925 W 34Th St Room #151
Los Angeles CA 90089-0641
Phone: (213) 740-7405
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Pathology | 1223P0106X | 24282 | California |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 24282 | California |
| Dental Providers / Dentist | 122300000X | 24282 | California |
Profile Details
| NPI number | 1740339233 |
|---|---|
| LBN Legal business name | Clark, Glen Thomas |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 10th, 2007 |
| Last updated | Dec 5th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740339233 | NPPES |
| California | Other | P00182356 | RAILROAD MEDICARE |
| California | Other | G100701 | RAILROAD MEDICARE |
| California | Other | ZZZ34010A | RAILROAD MEDICARE |
| California | Other | U0100701 | RAILROAD MEDICARE |
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