Provider Demographics
NPI:1013104793
Name:ARTIS L. CLARK, D.D.S.
Entity Type:Organization
Organization Name:ARTIS L. CLARK, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-333-4110
Mailing Address - Street 1:6724 TROOST AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1500
Mailing Address - Country:US
Mailing Address - Phone:816-333-1733
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12971261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental