Provider Demographics
NPI:1114173226
Name:DOWNEY, CLARK ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:ANDREW
Last Name:DOWNEY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2046
Mailing Address - Country:US
Mailing Address - Phone:321-254-8119
Mailing Address - Fax:
Practice Address - Street 1:6340 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2046
Practice Address - Country:US
Practice Address - Phone:321-254-8119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-09
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist