Provider Demographics
NPI:1114087616
Name:ARTHUR, CLARK K (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:K
Last Name:ARTHUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W NIFONG BLVD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6804
Mailing Address - Country:US
Mailing Address - Phone:573-449-1918
Mailing Address - Fax:573-817-3161
Practice Address - Street 1:601 W NIFONG BLVD
Practice Address - Street 2:SUITE 3A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6804
Practice Address - Country:US
Practice Address - Phone:573-449-1918
Practice Address - Fax:573-817-3161
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS029190OtherBCBS
MO114091OtherUNITED CONCORDIA