Provider Demographics
NPI:1427751502
Name:CLARK, CAMAYA ALISHA
Entity type:Individual
Prefix:
First Name:CAMAYA
Middle Name:ALISHA
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 MCKELL DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-6627
Mailing Address - Country:US
Mailing Address - Phone:901-409-7747
Mailing Address - Fax:
Practice Address - Street 1:3298 MCKELL DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6627
Practice Address - Country:US
Practice Address - Phone:901-409-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist