Provider Demographics
NPI:1073972964
Name:JAMES CLARK & ASSOCIATES, PC
Entity Type:Organization
Organization Name:JAMES CLARK & ASSOCIATES, PC
Other - Org Name:CHADBOURN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEBE
Authorized Official - Middle Name:GUNTER
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-863-2377
Mailing Address - Street 1:711 N BROWN ST
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-1307
Mailing Address - Country:US
Mailing Address - Phone:910-516-2067
Mailing Address - Fax:910-516-2161
Practice Address - Street 1:711 N BROWN ST
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-1307
Practice Address - Country:US
Practice Address - Phone:910-516-2067
Practice Address - Fax:910-516-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7917122300000X
NC97521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty