Individual
KENDRA NICOLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3880 HULEN ST STE 310, FORT WORTH, TX 76107-7274
(817) 737-7668
Mailing address
2225 MARILLA ST APT 4310, DALLAS, TX 75201-5959
(601) 213-4389
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
34365
TX
122300000X
Dentist
3992-18
MS
1223E0200X
Endodontics
Primary
34365
TX
1223E0200X
Endodontics
3992-18
MS
Other
Enumeration date
01/04/2020
Last updated
10/28/2020
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