| Doctor Name: | DR. SHANE THOMAS CLARK |
| NPI Number: | 1003220203 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DMD |
| License Number: | DD4100 |
| Business Practice Address: | 2800 Coors Blvd Nw Albuquerque, NM - 871201204 |
| Business Phone Number: | 5053521166 |
| Business Fax Number: | |
| Mailing Address: | 8400 Oakland Ave Ne, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871222721 |
| Phone Number: | 5126898382 |
| Fax Number: | |
| NPI Enumeration Date: | 06/16/2014 |
| NPI Last Update Date: | 09/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223E0200X |
| License Number: | DD4100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Endodontics |
| Taxonomy Definition: | The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |