Organization
L L CLARK DDS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY LEE CLARK DDS (DENTIST)
(608) 375-4549
Entity
Organization
Contact information
Practice address
105 EAST BLUFF STREET, BOSCOBEL, WI 53805-9802
(608) 375-4549
(608) 375-4665
Mailing address
105 EAST BLUFF STREET, BOSCOBEL, WI 53805-9802
(608) 375-4549
(608) 375-4665
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001678015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33549200
—
WI
Enumeration date
05/03/2006
Last updated
08/22/2020
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