Individual
REBECCA LEANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2030 N DIXIE HWY, ELIZAETTHTOWN, KY 42701
(270) 763-0200
Mailing address
7865B ESTRADA AVE, FORT KNOX, KY 40121-2321
(972) 765-5186
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10811
KY
Other
Enumeration date
06/24/2022
Last updated
06/24/2022
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