Organization
SHELLY K. CLARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLY K. CLARK DDS (OWNER)
(972) 291-0111
Entity
Organization
Contact information
Practice address
211 W BELT LINE RD, CEDAR HILL, TX 75104-2066
(972) 291-0111
(972) 291-0315
Mailing address
211 W BELT LINE RD, CEDAR HILL, TX 75104-2066
(972) 291-0111
(972) 291-0315
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
18113
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891880076
—
TX
Enumeration date
03/16/2012
Last updated
03/16/2012
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