Organization
DR. CHESTER V. CLARK, JR. D.D.S., M.P.H., P.C.
Active
Other names
Amity Gentle Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHESTER V CLARK JR. DDS, MPH (PRESIDENT)
(870) 342-5265
Entity
Organization
Contact information
Practice address
439 E THOMPSON ST, AMITY, AR 71921-8602
(870) 342-5265
(870) 342-6292
Mailing address
PO BOX 154, AMITY, AR 71921-0154
(870) 342-5265
(870) 342-6292
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2228
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101460608
—
AR
01
—
58932
ARKANSAS BCBS PROVIDER ID
AR
01
—
809875
UNITED CONCORDIA PROVIDER
AR
Enumeration date
11/14/2006
Last updated
01/25/2012
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