Organization
DR. JAMES L CLARK, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATISHA BOOTH (OFFICE MANAGER)
(580) 279-5760
Entity
Organization
Contact information
Practice address
116 E 14TH ST, ADA, OK 74820-6518
(580) 279-5760
Mailing address
PO BOX 458, ADA, OK 74821-0458
(580) 279-5760
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4245
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720161326
TEMP DENTIST
OK
Enumeration date
11/02/2017
Last updated
11/02/2017
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