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General NPI Number Information
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NPI Number | 1558906248
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Entity Type | Individual
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Provider Name | SARAH GRACE CLARK DDS
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Gender | Female
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Dates
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Enumeration Date | 11/17/2019
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 2425 PRINCE ST STE 1
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City | CONWAY
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State | AR
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Zip | 72034-3701
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Country | US
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Telephone | 903-486-2808
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Fax |
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Provider Business Mailing Address
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Address Line | 2545 GRUMMER LN
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City | CONWAY
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State | AR
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Zip | 72034-2012
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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 |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4384
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License Number State | AR
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