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General NPI Number Information
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NPI Number | 1235344052
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Entity Type | Individual
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Provider Name | JOHN WARREN CLARK DDS
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 8 MONUMENT SQUARE LN
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City | DOVER FOXCROFT
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State | ME
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Zip | 04426-1339
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Country | US
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Telephone | 207-564-8197
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Fax | 207-564-8489
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Provider Business Mailing Address
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Address Line | 753 STILLWATER AVE
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City | BANGOR
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State | ME
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Zip | 04401-3633
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Country | US
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Telephone | 207-990-5887
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Fax | 207-307-7002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3365
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License Number State | ME
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