Organization
CLARK & OTERO DDS PLLC
Active
Other names
Oak Grove Dental
Organization subpart
No
Provider details
NPI number
Authorized official
BEBE GUNTER JACKSON (MANAGER)
(910) 863-2377
Entity
Organization
Contact information
Practice address
103 GANYARD FARM WAY, DURHAM, NC 27703-6230
(919) 957-2444
(888) 505-9592
Mailing address
103 GANYARD FARM WAY, DURHAM, NC 27703
(919) 597-2444
(888) 505-9592
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NC
1223G0001X
General Practice Dentistry
9387
NC
1223G0001X
General Practice Dentistry
Primary
—
NC
Other
Enumeration date
12/03/2014
Last updated
07/21/2022
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