# CLARK & OTERO DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Oak Grove Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710384938
- **Authorized official:** BEBE GUNTER JACKSON (MANAGER)
- **Authorized official phone:** (910) 863-2377

## Contact information

- **Practice address:** 103 GANYARD FARM WAY, DURHAM, NC 27703-6230
- **Practice address phone:** (919) 957-2444
- **Practice address fax:** (888) 505-9592
- **Mailing address:** 103 GANYARD FARM WAY, DURHAM, NC 27703
- **Mailing address phone:** (919) 597-2444
- **Mailing address fax:** (888) 505-9592

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NC | — |
| 1223G0001X | General Practice Dentistry | 9387 | NC | — |
| 1223G0001X | General Practice Dentistry | — | NC | Yes |

## Other

- **Enumeration date:** 12/03/2014
- **Last updated:** 07/21/2022