Organization
CARROLLWOOD DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR L CLARK D.M.D. (OWNER)
(314) 739-3700
Entity
Organization
Contact information
Practice address
12147 NATURAL BRIDGE RD, BRIDGETON, MO 63044-2018
(314) 739-3700
(314) 739-5048
Mailing address
12147 NATURAL BRIDGE RD, BRIDGETON, MO 63044-2018
(314) 739-3700
(314) 739-5048
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
013326
MO
1223G0001X
General Practice Dentistry
14202
MO
1223G0001X
General Practice Dentistry
Primary
2003012113
MO
Other
Enumeration date
04/23/2007
Last updated
08/22/2020
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