Healthcare Provider Details

I. General information

NPI: 1306774385
Provider Name (Legal Business Name): DANIEL CLARK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S MARKET ST
DANVILLE OH
43014-3514
US

IV. Provider business mailing address

11100 EDWARDS RD
JOHNSTOWN OH
43031-9180
US

V. Phone/Fax

Practice location:
  • Phone: 740-240-4034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: