Healthcare Provider Details

I. General information

NPI: 1821220294
Provider Name (Legal Business Name): DOW CLARK DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6188 OXON HILL RD SUITE 604
OXON HILL MD
20745-3113
US

IV. Provider business mailing address

6188 OXON HILL RD SUITE 604
OXON HILL MD
20745-3113
US

V. Phone/Fax

Practice location:
  • Phone: 301-686-1070
  • Fax: 301-686-1072
Mailing address:
  • Phone: 301-686-1070
  • Fax: 301-686-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDRICK DOUGLASS CLARK
Title or Position: LEAD DOCTOR
Credential: DDS
Phone: 301-686-1070