Individual
DR. RICHARD GLENN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
444 N RIDGE RD, WICHITA, KS 67212-6574
(316) 942-5358
Mailing address
444 N RIDGE RD, WICHITA, KS 67212-6574
(316) 942-5358
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
61084
KS
1223G0001X
General Practice Dentistry
7550640-9921
UT
Other
Enumeration date
01/20/2010
Last updated
08/19/2014
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