Organization
DR. JOHHNY M CLARK DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA MARLIESSA CLARK (OFFICE MANAGER)
(254) 784-0508
Entity
Organization
Contact information
Practice address
121 N RICE ST, HAMILTON, TX 76531-1857
(254) 386-8957
(254) 386-3240
Mailing address
PO BOX 21, ENERGY, TX 76452-0021
(254) 784-0508
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12810
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090274402
—
TX
Enumeration date
08/31/2006
Last updated
04/04/2024
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