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Organization
CLARK FAMILY DENTISTRY PC
Active
Organization
CLARK FAMILY DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD LEE CLARK DMD (OWNER)
(541) 548-3896
Entity
Organization
Contact information
Practice address
2727 SW 17TH PL, REDMOND, OR 97756-1297
(541) 548-3896
(541) 548-1859
Mailing address
2727 SW 17TH PL, REDMOND, OR 97756-1297
(541) 548-3896
(541) 548-1859
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6918
OR
Other
Enumeration date
03/15/2012
Last updated
03/15/2012
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