Provider Demographics
NPI:1114173226
Name:DOWNEY, CLARK ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:ANDREW
Last Name:DOWNEY
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 1:10045 N STATE ROAD 1
Mailing Address - Street 2:
Mailing Address - City:OSSIAN
Mailing Address - State:IN
Mailing Address - Zip Code:46777-9781
Mailing Address - Country:US
Mailing Address - Phone:260-622-4138
Mailing Address - Fax:
Practice Address - Street 1:10045 N STATE ROAD 1
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IN
Practice Address - Zip Code:46777
Practice Address - Country:US
Practice Address - Phone:260-622-4138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-09
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist