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General NPI Number Information
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NPI Number | 1659738276
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Entity Type | Organization
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Legal Business Name | CLEAR CREEK DENTISTRY, PLLC
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 901 NORMAL PARK DR STE 202
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City | HUNTSVILLE
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State | TX
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Zip | 77320-3770
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Country | US
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Telephone | 617-319-6674
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Fax |
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Provider Business Mailing Address
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Address Line | 5430 PINE SPRINGS CT
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City | CONROE
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State | TX
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Zip | 77304-4052
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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 | JEFFREY CLARK
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Credential | D.M.D.
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Telephone | 936-291-0032
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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 | 27909
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License Number State | TX
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