Organization
BRACES ON THE BRAZOS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH LEE CLARK DDS (ORTHODONTIST)
(318) 455-1121
Entity
Organization
Contact information
Practice address
1116 N MEADOWS DR, GRANBURY, TX 76048-1717
(817) 573-4746
Mailing address
1116 N MEADOWS DR, GRANBURY, TX 76048-1717
(318) 455-1121
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
02/14/2019
Last updated
03/02/2023
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