Healthcare Provider Details

I. General information

NPI: 1811642895
Provider Name (Legal Business Name): CALLI LAYNE CLARK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 DORCHESTER RD STE 104
NORTH CHARLESTON SC
29420-7382
US

IV. Provider business mailing address

180 PATRIOTS POINT RD APT 503
MOUNT PLEASANT SC
29464-5437
US

V. Phone/Fax

Practice location:
  • Phone: 843-473-6636
  • Fax:
Mailing address:
  • Phone: 570-394-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10937
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10733
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: