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General NPI Number Information
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NPI Number | 1134374507
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Entity Type | Organization
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Legal Business Name | R. LYNN CLARK, D.D.S., P.C.
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Dates
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Enumeration Date | 11/26/2008
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Last Update Date | 11/26/2008
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Provider Practice Location Address
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Address Line | 301 S BOULEVARD ST
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City | EDMOND
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State | OK
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Zip | 73034-3878
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Country | US
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Telephone | 405-348-9182
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S BOULEVARD ST
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City | EDMOND
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State | OK
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Zip | 73034-3878
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Country | US
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Telephone | 405-348-9182
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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. RANDOLPH LYNN CLARK
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Credential | D.D.S.
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Telephone | 405-348-9182
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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 |
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License Number State |
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