Healthcare Provider Details

I. General information

NPI: 1023688686
Provider Name (Legal Business Name): ARIELLE BARRACA CLARK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARIELLE BERNAL BARRACA

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 HIGHWAY 14 E
LANDRUM SC
29356-9727
US

IV. Provider business mailing address

1249 OWENS RD
GREER SC
29651-5565
US

V. Phone/Fax

Practice location:
  • Phone: 864-457-3425
  • Fax:
Mailing address:
  • Phone: 864-993-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDGD.9916
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDGD.9916
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: