Organization
COLE AND CLARK DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM JAMES CLARK DDS, MD (OWNER)
(805) 983-3131
Entity
Organization
Contact information
Practice address
1801 SOLAR DR, #100, OXNARD, CA 93030-8234
(805) 983-3131
(805) 983-3000
Mailing address
1801 SOLAR DR, #100, OXNARD, CA 93030-8234
(805) 983-3131
(805) 983-3000
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
39247
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
39247
CA
1223X0008X
Oral and Maxillofacial Radiology Dentistry
39247
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B29573-01
—
CA
01
—
W14838
MEDICARE GP #
CA
Enumeration date
10/16/2007
Last updated
04/11/2013
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