Provider Demographics
NPI:1346401767
Name:STEFFENS, CLARK WILSON I (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:WILSON
Last Name:STEFFENS
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CLARK
Other - Middle Name:WILSON
Other - Last Name:STEFFENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2828 ROUTH ST
Mailing Address - Street 2:STE 310
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1462
Mailing Address - Country:US
Mailing Address - Phone:214-969-1000
Mailing Address - Fax:214-969-1001
Practice Address - Street 1:2828 ROUTH ST
Practice Address - Street 2:STE 310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1462
Practice Address - Country:US
Practice Address - Phone:214-969-1000
Practice Address - Fax:214-969-1001
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice