Provider Demographics
NPI:1336466283
Name:CLARK, KRISTIN DUMBOSKI (DDS, MS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DUMBOSKI
Last Name:CLARK
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ERIN
Other - Last Name:DUMBOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5503 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6707
Mailing Address - Country:US
Mailing Address - Phone:501-758-4112
Mailing Address - Fax:501-758-4117
Practice Address - Street 1:5503 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6707
Practice Address - Country:US
Practice Address - Phone:501-758-4112
Practice Address - Fax:501-758-4117
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics