Organization
TRAVIS CLARK DDS LLC
Active
Other names
Family Dental Care Of Lebanon
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS CLARK DDS (DENTIST)
(614) 937-0509
Entity
Organization
Contact information
Practice address
1248 COLUMBUS AVE STE 8, LEBANON, OH 45036-9005
(513) 932-0432
(513) 932-0152
Mailing address
7845 PLANTATION DR, MASON, OH 45040-5944
(614) 937-0509
(513) 932-0152
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2668466
—
OH
Enumeration date
09/08/2020
Last updated
09/08/2020
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