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General NPI Number Information
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NPI Number | 1659374221
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Entity Type | Individual
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Provider Name | PAMELA CLARK DDS
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Gender | Female
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2360 COUNTY ROAD 94 STE 102
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City | PEARLAND
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State | TX
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Zip | 77584-4884
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Country | US
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Telephone | 713-436-4080
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 ROSEDALE ST
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City | HOUSTON
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State | TX
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Zip | 77004-5652
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Country | US
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Telephone | 713-436-4080
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 20292
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License Number State | TX
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