Organization
JOHN NICHOLAS CLARK D.D.S., PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN NICHOLAS CLARK D.D.S. (PRESIDENT)
(479) 466-3834
Entity
Organization
Contact information
Practice address
810 LOCUST ST, CONWAY, AR 72034-5331
(501) 327-4589
Mailing address
810 LOCUST ST, CONWAY, AR 72034-5331
(501) 327-4589
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3810
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187121608
—
AR
Enumeration date
10/01/2012
Last updated
10/01/2012
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