Provider Demographics
NPI:1649433640
Name:CLARK-FASS, LINDSEY MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:MARIE
Last Name:CLARK-FASS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LINDSEY
Other - Middle Name:MARIE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2409 YORKSTOWN DR.
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119
Mailing Address - Country:US
Mailing Address - Phone:972-875-3400
Mailing Address - Fax:972-875-4020
Practice Address - Street 1:504 S CLAY ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4551
Practice Address - Country:US
Practice Address - Phone:972-875-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice