Organization
SHELLY K. CLARK, DENTISTRY FOR CHILDREN
Active
Parent organization
SHELLY K. CLARK, DENTISTRY FOR CHILDREN
Other names
Shelly K. Clark, DDS Dentistry for Children
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHELLY K. CLARK, DENTISTRY FOR CHILDREN
Authorized official
DR. SHELLY CLARK DDS (OWNER)
(972) 291-4281
Entity
Organization
Contact information
Practice address
4450 E HIGHWAY 287, MIDLOTHIAN, TX 76065-5576
(972) 723-0111
Mailing address
4450 E HIGHWAY 287, MIDLOTHIAN, TX 76065-5576
(972) 723-0111
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210909202
—
TX
Enumeration date
12/14/2020
Last updated
12/14/2020
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