Provider Demographics
NPI:1649272121
Name:CLOCK, ADAM DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DOUGLAS
Last Name:CLOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 PLAZA DR STE J
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2940
Mailing Address - Country:US
Mailing Address - Phone:812-376-9335
Mailing Address - Fax:812-376-9298
Practice Address - Street 1:530 PLAZA DR STE J
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2940
Practice Address - Country:US
Practice Address - Phone:812-376-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-13
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010542A1223S0112X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery