Provider Demographics
NPI:1083733786
Name:CLARK HOWARD, SANDRA RENE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:RENE
Last Name:CLARK HOWARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 FREDERICA ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301
Mailing Address - Country:US
Mailing Address - Phone:270-684-7244
Mailing Address - Fax:270-683-0545
Practice Address - Street 1:920 FREDERICA ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-684-7244
Practice Address - Fax:270-683-0545
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist