Organization
ILLUMINATE FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RACHEL HAYES CLARK DDS (OWNER DENTIST)
(316) 847-7730
Entity
Organization
Contact information
Practice address
250 W RED POWELL DR STE 500, DERBY, KS 67037-2626
(316) 847-7730
Mailing address
2113 N WOODARD ST, DERBY, KS 67037-2364
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/04/2022
Last updated
02/04/2022
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