Provider Demographics
NPI:1699012021
Name:CLARK-AYIK DENTAL WESTLAKE PLLC
Entity Type:Organization
Organization Name:CLARK-AYIK DENTAL WESTLAKE PLLC
Other - Org Name:FLOSS WESTLAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-854-2960
Mailing Address - Street 1:2785 BEE CAVE RD
Mailing Address - Street 2:SUITE 331
Mailing Address - City:ROLLINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5798
Mailing Address - Country:US
Mailing Address - Phone:512-782-0820
Mailing Address - Fax:
Practice Address - Street 1:2785 BEE CAVE RD
Practice Address - Street 2:SUITE 331
Practice Address - City:ROLLINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:78746-5798
Practice Address - Country:US
Practice Address - Phone:512-782-0820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty