Provider Demographics
NPI:1669668950
Name:CLARK, ARTIS LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTIS
Middle Name:LEE
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 1:6724 TROOST AVE
Mailing Address - Street 2:114
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1500
Mailing Address - Country:US
Mailing Address - Phone:816-333-4110
Mailing Address - Fax:816-333-1733
Practice Address - Street 1:6724 TROOST AVE
Practice Address - Street 2:114
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1500
Practice Address - Country:US
Practice Address - Phone:816-333-4110
Practice Address - Fax:816-333-1733
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice