Provider Demographics
NPI:1659374221
Name:CLARK, PAMELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
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 1:1409 ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5652
Mailing Address - Country:US
Mailing Address - Phone:713-436-4080
Mailing Address - Fax:
Practice Address - Street 1:2360 COUNTY ROAD 94
Practice Address - Street 2:STE 102
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4884
Practice Address - Country:US
Practice Address - Phone:713-436-4080
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry