Healthcare Provider Details

I. General information

NPI: 1760091409
Provider Name (Legal Business Name): MEREDITH CLARK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-5700
US

IV. Provider business mailing address

2002 LAGRANGE DR
FORT LIBERTY NC
28314
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8922
  • Fax:
Mailing address:
  • Phone: 248-514-5132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901600477
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901600477
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: