Individual
KYLE ALLEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
113 CROSS CREEK BLVD, SALEM, IL 62881-1921
(618) 548-4480
Mailing address
113 CROSS CREEK BLVD, SALEM, IL 62881-1921
(618) 548-4480
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019030831
IL
Other
Enumeration date
07/07/2016
Last updated
07/07/2016
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