Individual
DR. JOHN NICHOLAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
810 LOCUST ST, CONWAY, AR 72034-5331
(479) 466-3834
Mailing address
810 LOCUST ST, CONWAY, AR 72034-5331
(479) 466-3834
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3810
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187121608
—
AR
Enumeration date
07/27/2009
Last updated
10/01/2012
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