Individual
DR. ALAN DOUGLAS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
745 E. JOYCE, STE 221, FAYETTEVILLE, AR 72703
(479) 443-1849
(479) 443-2034
Mailing address
745 E. JOYCE, STE 221, FAYETTEVILLE, AR 72703
(479) 443-1849
(479) 443-2034
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3349
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143894608
—
AR
01
—
412175658
NEW TAX ID #
AR
01
—
870436704
OLD TAX ID #
AR
Enumeration date
08/04/2006
Last updated
10/26/2012
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