Provider Demographics
NPI:1932198694
Name:CLARK, H. DANIEL (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:H.
Middle Name:DANIEL
Last Name:CLARK
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 STANSBERRY LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-5125
Mailing Address - Country:US
Mailing Address - Phone:615-591-0919
Mailing Address - Fax:615-599-6762
Practice Address - Street 1:3000 STANSBERRY LN
Practice Address - Street 2:SUITE 101
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069
Practice Address - Country:US
Practice Address - Phone:615-591-0919
Practice Address - Fax:615-599-6762
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000081111223S0112X
TNMD0000037255204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNV06221Medicare UPIN
TN3227611Medicare ID - Type Unspecified