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General NPI Number Information
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NPI Number | 1255520235
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Entity Type | Organization
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Legal Business Name | COLE AND CLARK DENTAL CORPORATION
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 1801 SOLAR DR #100
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City | OXNARD
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State | CA
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Zip | 93030-8234
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Country | US
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Telephone | 805-983-3131
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Fax | 805-983-3000
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Provider Business Mailing Address
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Address Line | 1801 SOLAR DR #100
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City | OXNARD
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State | CA
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Zip | 93030-8234
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Country | US
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Telephone | 805-983-3131
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Fax | 805-983-3000
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM JAMES CLARK
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Credential | DDS, MD
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Telephone | 805-983-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 39247
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | 39247
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 39247
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License Number State | CA
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