Individual
MR. DALE WOODALL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
204 EAST FOURTH ST, RUSSELLVILLE, KY 42276
(270) 726-7511
(270) 726-6831
Mailing address
204 EAST FOURTH ST, RUSSELLVILLE, KY 42276
(270) 726-7511
(270) 726-6831
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5933
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60059334
—
KY
Enumeration date
08/30/2006
Last updated
07/08/2007
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