Provider Demographics
NPI:1235249160
Name:DENNIS P. CLARK, D.M.D., P.C.
Entity Type:Organization
Organization Name:DENNIS P. CLARK, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-245-1100
Mailing Address - Street 1:9430 SW CORAL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6691
Mailing Address - Country:US
Mailing Address - Phone:503-245-1100
Mailing Address - Fax:503-473-8300
Practice Address - Street 1:9430 SW CORAL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6691
Practice Address - Country:US
Practice Address - Phone:503-245-1100
Practice Address - Fax:503-473-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD78291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty