Individual
DR. RICHARD JAMES CLARK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2300 GARRETT RD, DREXEL HILL, PA 19026-1102
(610) 623-4211
(610) 623-2850
Mailing address
2300 GARRETT RD, DREXEL HILL, PA 19026-1102
(610) 623-4211
(610) 623-2850
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS024574L
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DS024574L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1172921
—
PA
Enumeration date
06/06/2006
Last updated
04/22/2008
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