Provider Demographics
NPI:1891880076
Name:CLARK, SHELLY KAY (DDS)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:KAY
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 1:211 W BELT LINE RD
Mailing Address - Street 2:NORTH SUITE
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2066
Mailing Address - Country:US
Mailing Address - Phone:972-291-0111
Mailing Address - Fax:
Practice Address - Street 1:211 W BELT LINE RD
Practice Address - Street 2:NORTH SUITE
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2066
Practice Address - Country:US
Practice Address - Phone:972-291-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry