Provider Demographics
NPI:1699443192
Name:CLARK-GOLD, ZANE MATTHEW (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ZANE
Middle Name:MATTHEW
Last Name:CLARK-GOLD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 4TH ST SE UNIT 128
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3883
Mailing Address - Country:US
Mailing Address - Phone:253-302-2106
Mailing Address - Fax:
Practice Address - Street 1:11601 MINNETONKA MILLS RD STE F40
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305-5189
Practice Address - Country:US
Practice Address - Phone:952-935-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR8121223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty