Provider Demographics
NPI:1770501793
Name:CLARK, JAMES W (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:CLARK
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:3100 E EISENHOWER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-5205
Mailing Address - Country:US
Mailing Address - Phone:734-971-3368
Mailing Address - Fax:734-971-3979
Practice Address - Street 1:3100 E EISENHOWER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5205
Practice Address - Country:US
Practice Address - Phone:734-971-3368
Practice Address - Fax:734-971-3979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI101131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry