Individual
DR. RANDOLPH LYNN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
301 S BOULEVARD ST, SUITE 118, EDMOND, OK 73034-3878
(405) 348-9182
(405) 330-1677
Mailing address
301 S BOULEVARD ST, SUITE 118, EDMOND, OK 73034-3878
(405) 348-9182
(405) 330-1677
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
OK4992
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73-137-9303
FEDERAL TAX I.D
OK
Enumeration date
11/29/2006
Last updated
12/26/2008
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