Organization
DR. DARRELL ADRIAN CLARK D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRELL ADRIAN CLARK D.D.S. (PRESIDENT)
(301) 512-0132
Entity
Organization
Contact information
Practice address
12070 OLD LINE CTR, WALDORF, MD 20602-2513
(301) 638-0282
Mailing address
3102 DUNKAGLE CT, BOWIE, MD 20721-1261
(301) 512-0132
(301) 218-1623
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
8308
MD
Other
Enumeration date
04/25/2007
Last updated
07/12/2011
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