MEDICARE: DR. H. DANIEL CLARK DDS, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS0000008111	TN
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	MD0000037255	TN

General Provider Information

NPI Number	:	1932198694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. H. DANIEL CLARK DDS, MD

Provider Business Mailing Address
First Line	:	3000 STANSBERRY LN
Second Line	:	SUITE 101
City	:	FRANKLIN
State	:	TN
Zip	:	37069-5125
Country	:	US
Telephone Number	:	615-591-0919
Fax Number	:	615-599-6762

Provider Business Practice Location Address
First Line	:	3000 STANSBERRY LN
Second Line	:	SUITE 101
City	:	FRANKLIN
State	:	TN
Zip	:	37069
Country	:	US
Telephone Number	:	615-591-0919
Fax Number	:	615-599-6762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	03/22/2013

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