Organization
DRS PETER AND LISA CLARK FAMILY AND COSMETIC DENTISTRY
Active
Other names
Bonham Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M CLARK DMD (CORP SECRETARY)
(903) 583-8023
Entity
Organization
Contact information
Practice address
101 E 9TH STREET, BONHAM, TX 75418
(903) 583-8023
(903) 583-1291
Mailing address
101 E 9TH STREET, BONHAM, TX 75418
(903) 583-8023
(903) 583-1291
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
20340
TX
1223G0001X
General Practice Dentistry
Primary
20341
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1318239
UNITED CONCORDIA
—
Enumeration date
08/31/2006
Last updated
08/22/2020
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