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Individual

DR. KATHERINE ELIZABETH CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
130 BEN CASEY DR, SUITE 105, FORT MILL, SC 29708-6567
(803) 547-8200
Mailing address
130 BEN CASEY DR, SUITE 105, FORT MILL, SC 29708-6567
(803) 547-8200

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4123
SC
1223P0221X
Pediatric Dentistry
4123
SC
1223P0221X
Pediatric Dentistry
9012
NC

Other

Enumeration date
07/26/2006
Last updated
07/10/2012
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