Provider Demographics
NPI:1497812663
Name:CLARK, FRANKLIN (DDS,PC)
Entity Type:Individual
Prefix:MR
First Name:FRANKLIN
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 E REELFOOT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5870
Mailing Address - Country:US
Mailing Address - Phone:731-885-2002
Mailing Address - Fax:731-885-2072
Practice Address - Street 1:1003 E REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5870
Practice Address - Country:US
Practice Address - Phone:731-885-2002
Practice Address - Fax:731-885-2072
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice