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Organization
DRS PETER AND LISA CLARK FAMILY AND COSMETIC DENTISTRY
Active
Organization
DRS PETER AND LISA CLARK FAMILY AND COSMETIC DENTISTRY
Active
Other names
Bonham Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M CLARK DMD (CORP SECRETARY)
(903) 583-8023
Entity
Organization
Contact information
Practice address
101 E 9TH STREET, BONHAM, TX 75418
(903) 583-8023
(903) 583-1291
Mailing address
101 E 9TH STREET, BONHAM, TX 75418
(903) 583-8023
(903) 583-1291
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
20340
TX
1223G0001X
General Practice Dentistry
Primary
20341
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1318239
UNITED CONCORDIA
—
Enumeration date
08/31/2006
Last updated
08/22/2020
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