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General NPI Number Information
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NPI Number | 1013104793
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Entity Type | Organization
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Legal Business Name | ARTIS L. CLARK, D.D.S.
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 6724 TROOST AVE 114
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City | KANSAS CITY
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State | MO
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Zip | 64131-1500
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Country | US
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Telephone | 816-333-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 6724 TROOST AVE
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City | KANSAS CITY
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State | MO
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Zip | 64131-1500
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Country | US
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Telephone | 816-333-1733
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ARTIS LEE CLARK SR.
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Credential | D.D.S.
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Telephone | 816-333-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12971
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License Number State | MO
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