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Organization
W.A. CLARK, D.D.S., P.L.L.C.
Active
Organization
W.A. CLARK, D.D.S., P.L.L.C.
Active
Other names
Clark Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALEED AJAMU CLARK DDS (OWNER)
(202) 271-3096
Entity
Organization
Contact information
Practice address
1040 NE 36TH ST, OKLAHOMA CITY, OK 73111-5002
(405) 427-5405
Mailing address
612 BELLEMEADE ST, GREENSBORO, NC 27401-1903
(202) 271-3096
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6354
OK
Other
Enumeration date
03/04/2013
Last updated
03/04/2013
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