Provider Demographics
NPI:1598793747
Name:CLARK, JANET C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:C
Last Name:CLARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9080 PICKWICK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1714
Mailing Address - Country:US
Mailing Address - Phone:317-575-8491
Mailing Address - Fax:
Practice Address - Street 1:7890 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3105
Practice Address - Country:US
Practice Address - Phone:317-271-9727
Practice Address - Fax:317-273-2373
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008748A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry