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Organization

FERGUSON DENTAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. VICTOR L CLARK D.M.D. (DENTIST/OWNER)
(314) 522-6300
Entity
Organization

Contact information

Practice address
46 S FLORISSANT RD, FERGUSON, MO 63135-2334
(314) 522-6300
Mailing address
46 S FLORISSANT RD, FERGUSON, MO 63135-2334
(314) 522-6300

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
03/30/2011
Last updated
03/30/2011
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