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General NPI Number Information
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NPI Number | 1700215175
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Entity Type | Organization
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Legal Business Name | KRISTIN D. CLARK DDS, MS, PA
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 5503 JOHN F. KENNEDY BLVD.
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116
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Country | US
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Telephone | 501-758-4112
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Fax | 501-758-4117
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Provider Business Mailing Address
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Address Line | 5503 JOHN F. KENNEDY BLVD.
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116
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Country | US
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Telephone | 501-758-4112
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Fax | 501-758-4117
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | KRISTIN D CLARK
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Credential | DDS, MS, PA
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Telephone | 501-758-4112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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