Provider Demographics
NPI:1023688686
Name:CLARK, ARIELLE BARRACA (DMD)
Entity type:Individual
Prefix:DR
First Name:ARIELLE
Middle Name:BARRACA
Last Name:CLARK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ARIELLE
Other - Middle Name:BERNAL
Other - Last Name:BARRACA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1249 OWENS RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-5565
Mailing Address - Country:US
Mailing Address - Phone:864-993-7954
Mailing Address - Fax:
Practice Address - Street 1:1730 HIGHWAY 14 E
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356-9727
Practice Address - Country:US
Practice Address - Phone:864-457-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.99161223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice