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General NPI Number Information
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NPI Number | 1417743873
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Entity Type | Organization
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Legal Business Name | RICHARD CLARK DMD, LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 222 S NEWTOWN STREET RD
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-4000
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Country | US
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Telephone | 610-801-1502
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Fax | 610-648-2470
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Provider Business Mailing Address
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Address Line | 217 S ITHAN AVE
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City | BRYN MAWR
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State | PA
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Zip | 19010-1044
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Country | US
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Telephone |
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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. RICHARD JOSEPH CLARK
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Credential | DMD
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Telephone | 610-801-1502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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