Individual
DR. CHESTER VAN CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.P.H.
Contact information
Practice address
439 E THOMPSON ST, AMITY, AR 71921-8602
(870) 342-5265
(870) 342-6292
Mailing address
439 E THOMPSON ST, AMITY, AR 71921-8602
(870) 342-5265
(870) 342-6292
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR2228
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101460608
—
AR
Enumeration date
02/01/2012
Last updated
02/01/2012
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