Individual
BENJAMIN ALLEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1220 N WASHINGTON AVE, DURANT, OK 74701-2120
(580) 745-5400
Mailing address
1220 N WASHINGTON AVE, DURANT, OK 74701-2120
(580) 745-5400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6633
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6633
OKLAHOMA BOARD OF DENTISTRY
OK
Enumeration date
06/30/2014
Last updated
06/30/2014
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