Individual
DR. KEITH LEE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1116 N MEADOWS DR, GRANBURY, TX 76048-1717
(817) 573-4746
Mailing address
3101 RIO GRANDE CIR, CRESSON, TX 76035-4193
(318) 455-1121
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
19558
TX
Other
Enumeration date
10/23/2006
Last updated
03/02/2023
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