Organization
DANIEL J. CLARK, DDS, INC.
Active
Other names
Clark Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL J. CLARK D.D.S. (OWNER)
(937) 393-3494
Entity
Organization
Contact information
Practice address
624 SOUTH HIGH STREET, HILLSBORO, OH 45133
(937) 393-3494
(937) 393-6864
Mailing address
PO BOX 310, HILLSBORO, OH 45133
(937) 393-3494
(937) 393-6864
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
15180
OH
122300000X
Dentist
Primary
18843
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0854375
—
OH
01
—
792420
UNITED HEALTHCARE
—
Enumeration date
07/07/2005
Last updated
03/15/2010
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