Individual
DR. TRAVIS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1248 COLUMBUS AVE, STE 8, LEBANON, OH 45036
(513) 932-0432
Mailing address
1248 COLUMBUS AVE, SUITE 8, LEBANON, OH 45036
(513) 932-0432
(513) 932-0152
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30022366
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2668466
—
OH
Enumeration date
10/25/2006
Last updated
07/08/2007
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