Individual
DR. BENJAMIN TODD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(210) 292-8629
Mailing address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(210) 292-8629
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
8412
TN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
24280
TX
Other
Enumeration date
01/09/2006
Last updated
08/17/2023
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