Individual
BETSEY ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
419 WALNUT ST, ELMIRA, NY 14901-2406
(607) 733-1715
Mailing address
419 WALNUT ST, ELMIRA, NY 14901-2406
(607) 733-1715
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
P70283
NY
1223G0001X
General Practice Dentistry
Primary
050012
NY
Other
Enumeration date
06/09/2009
Last updated
11/01/2012
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