Individual
DR. GRACE XINXING CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4716 ILLINOIS RD STE 101, FORT WAYNE, IN 46804-5123
(260) 432-7970
Mailing address
5120 BROOKSTONE WAY, INDIANAPOLIS, IN 46268-5417
(812) 251-6241
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12012818A
IN
Other
Enumeration date
11/20/2017
Last updated
01/12/2018
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