Provider Demographics
NPI:1548382021
Name:CLARK, JAMES OLDHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:OLDHAM
Last Name:CLARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 MANN DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5538
Mailing Address - Country:US
Mailing Address - Phone:704-845-5538
Mailing Address - Fax:
Practice Address - Street 1:3563 MATTHEWS MINT HILL RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3613
Practice Address - Country:US
Practice Address - Phone:704-847-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice