| Doctor Name: | DR. SAMANTHA ALEXANDRIA CLARK |
| NPI Number: | 1174967277 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DDS |
| License Number: | 390200000 |
| Business Practice Address: | 5 4th Ave. E. Polson, MT - 59860 |
| Business Phone Number: | 4067453525 |
| Business Fax Number: | 4067453529 |
| Mailing Address: | P.o. Box 880, ST. IGNATIUS |
| State: | MT |
| Postal Code: | 59865 |
| Phone Number: | 4067453525 |
| Fax Number: | 4067453529 |
| NPI Enumeration Date: | 04/19/2013 |
| NPI Last Update Date: | 09/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 390200000 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |