# DRS PETER AND LISA CLARK FAMILY AND COSMETIC DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bonham Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376655357
- **Authorized official:** LISA M CLARK DMD (CORP SECRETARY)
- **Authorized official phone:** (903) 583-8023

## Contact information

- **Practice address:** 101 E 9TH STREET, BONHAM, TX 75418
- **Practice address phone:** (903) 583-8023
- **Practice address fax:** (903) 583-1291
- **Mailing address:** 101 E 9TH STREET, BONHAM, TX 75418
- **Mailing address phone:** (903) 583-8023
- **Mailing address fax:** (903) 583-1291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 20340 | TX | — |
| 1223G0001X | General Practice Dentistry | 20341 | TX | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1318239 | UNITED CONCORDIA | — |