Provider Demographics
NPI:1861602310
Name:HUNG, CLARK D (DMD)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:D
Last Name:HUNG
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 1:1100 WEMBLEY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1604
Mailing Address - Country:US
Mailing Address - Phone:610-995-9585
Mailing Address - Fax:
Practice Address - Street 1:1100 WEMBLEY DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1604
Practice Address - Country:US
Practice Address - Phone:610-995-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029180L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice