Provider Demographics
NPI:1013289776
Name:CLINKSCALES DENTAL
Entity type:Organization
Organization Name:CLINKSCALES DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CLINKSCALES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-866-9541
Mailing Address - Street 1:590 DOWLEN RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6014
Mailing Address - Country:US
Mailing Address - Phone:409-866-9541
Mailing Address - Fax:409-866-0622
Practice Address - Street 1:590 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6014
Practice Address - Country:US
Practice Address - Phone:409-866-9541
Practice Address - Fax:409-866-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty