Individual
ROBERT S. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2533 LARKIN RD, SUITE 101, LEXINGTON, KY 40503-3278
(859) 278-9376
(859) 276-0260
Mailing address
2533 LARKIN RD, SUITE 101, LEXINGTON, KY 40503-3278
(859) 278-9376
(859) 276-0260
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
6624
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
6624
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60066248
—
KY
05
—
64066244
—
KY
Enumeration date
07/11/2006
Last updated
02/08/2016
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