Provider Demographics
NPI:1275293532
Name:CLARK & ASSOCIATE'S DENTISTRY
Entity Type:Organization
Organization Name:CLARK & ASSOCIATE'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:317-752-4719
Mailing Address - Street 1:7830 ROCKVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3130
Mailing Address - Country:US
Mailing Address - Phone:317-995-2939
Mailing Address - Fax:
Practice Address - Street 1:8001 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5970
Practice Address - Country:US
Practice Address - Phone:317-882-1536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty