Provider Demographics
NPI:1730872177
Name:CLARK, JOSHUA CADE (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:CADE
Last Name:CLARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 N THUNDERBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1545
Mailing Address - Country:US
Mailing Address - Phone:480-489-4731
Mailing Address - Fax:
Practice Address - Street 1:1959 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7356
Practice Address - Country:US
Practice Address - Phone:480-757-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist