Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Charlie E Clark, DMD

Individual provider Dentist · NPI 1417103482

Dr. Charlie E Clark, DMD is a Dentist in Surprise, Arizona. Licensed in Arizona and Wisconsin. Registered with an NPI since 2008.

Licensed in
AZ, WI
In the registry since
2008
Specialties on file
2
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

15264 W Brookside Ln
Surprise, AZ 85374-3989
Phone: (623) 474-3975
Fax: (623) 474-3198
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D7793 (AZ)
Dentist Taxonomy 122300000X · Licence 6303-15 (WI)

Record details

NPI number1417103482
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorNo
NPI enumeratedAugust 11, 2008
Last updated in NPPESAugust 4, 2009
Mailing address15264 W Brookside Ln, Surprise, AZ 85374-3989

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