Individual
DR. PATRICIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
221 S 19TH ST, TERRE HAUTE, IN 47807-4129
(812) 235-1598
Mailing address
221 S 19TH ST, TERRE HAUTE, IN 47807-4129
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
7844
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100065720A
—
IN
Enumeration date
01/04/2011
Last updated
01/04/2011
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