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General NPI Number Information
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NPI Number | 1073972964
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Entity Type | Organization
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Legal Business Name | JAMES CLARK & ASSOCIATES, PC
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Dates
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Enumeration Date | 02/19/2016
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 711 N BROWN ST
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City | CHADBOURN
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State | NC
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Zip | 28431-1307
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Country | US
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Telephone | 910-516-2067
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Fax | 910-516-2161
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Provider Business Mailing Address
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Address Line | 711 N BROWN ST
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City | CHADBOURN
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State | NC
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Zip | 28431-1307
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Country | US
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Telephone | 910-516-2067
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Fax | 910-516-2161
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BEBE GUNTER JACKSON
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Credential |
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Telephone | 910-863-2377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9752
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7917
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License Number State | NC
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