# CLARK ORAL & FACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clark Oral & Facial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649040858
- **Authorized official:** DR. PAUL CLARK III DMD, MD (SURGEON, OWNER)
- **Authorized official phone:** (503) 927-6845

## Contact information

- **Practice address:** 1502 LOCUST ST N STE 103, TWIN FALLS, ID 83301-6375
- **Practice address phone:** (208) 831-2900
- **Mailing address:** 1502 LOCUST ST N STE 103, TWIN FALLS, ID 83301-6375
- **Mailing address phone:** (208) 831-2900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 01/08/2024
- **Last updated:** 01/08/2024