Organization
BRACES ON THE BRAZOS PLLC
Active
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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