Individual
DR. ROBERT LAURISTON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9001 SPENCER HWY STE J, LA PORTE, TX 77571-3897
(281) 394-0517
Mailing address
3102 DUNKAGLE CT, BOWIE, MD 20721-1261
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
061019
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
16781
MD
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
39262
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2018
Last updated
06/18/2024
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