Provider Demographics
NPI:1265662217
Name:ADAM D. CLOCK, D.D.S., L.L.C.
Entity Type:Organization
Organization Name:ADAM D. CLOCK, D.D.S., L.L.C.
Other - Org Name:TIPTON PARK DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-376-9335
Mailing Address - Street 1:530 PLAZA DR STE J
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2940
Mailing Address - Country:US
Mailing Address - Phone:812-376-9335
Mailing Address - Fax:812-376-9298
Practice Address - Street 1:530 PLAZA DR STE J
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2940
Practice Address - Country:US
Practice Address - Phone:812-376-9335
Practice Address - Fax:812-376-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010542A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty