Provider Demographics
NPI:1619147964
Name:STRANGE, JR., D. CLARK (DMD)
Entity Type:Individual
Prefix:
First Name:D.
Middle Name:CLARK
Last Name:STRANGE, JR.
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S WHEATLEY ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5000
Mailing Address - Country:US
Mailing Address - Phone:601-956-0004
Mailing Address - Fax:601-572-8732
Practice Address - Street 1:805 S WHEATLEY ST
Practice Address - Street 2:SUITE 510
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5000
Practice Address - Country:US
Practice Address - Phone:601-956-0004
Practice Address - Fax:601-572-8732
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS233-931223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics