# DR. JOHHNY M CLARK DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831200427
- **Authorized official:** LYNDA MARLIESSA CLARK (OFFICE MANAGER)
- **Authorized official phone:** (254) 784-0508

## Contact information

- **Practice address:** 121 N RICE ST, HAMILTON, TX 76531-1857
- **Practice address phone:** (254) 386-8957
- **Practice address fax:** (254) 386-3240
- **Mailing address:** PO BOX 21, ENERGY, TX 76452-0021
- **Mailing address phone:** (254) 784-0508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12810 | TX | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 04/04/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 090274402 | — | TX |