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Individual
BENJAMIN ALLEN CLARK
Active
Individual
BENJAMIN ALLEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6633
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6633
OKLAHOMA BOARD OF DENTISTRY
OK
Enumeration date
06/30/2014
Last updated
06/30/2014
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