Provider Demographics
NPI:1174644421
Name:CLARK, ANTHONY RHODEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:RHODEN
Last Name:CLARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 CHAMBERLAIN LN
Mailing Address - Street 2:SUITTE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2001
Mailing Address - Country:US
Mailing Address - Phone:502-412-2222
Mailing Address - Fax:502-412-7744
Practice Address - Street 1:3707 CHAMBERLAIN LN
Practice Address - Street 2:SUITTE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2001
Practice Address - Country:US
Practice Address - Phone:502-412-2222
Practice Address - Fax:502-412-7744
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist