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General NPI Number Information
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NPI Number | 1760524342
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Entity Type | Organization
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Legal Business Name | R JOSEPH CLARK DDS PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 N CHESTNUT ST
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City | SEYMOUR
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State | IN
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Zip | 47274
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Country | US
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Telephone | 812-522-7360
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 684
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City | SEYMOUR
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State | IN
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Zip | 47274
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Country | US
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Telephone | 812-522-7360
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. R JOSEPH CLARK
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Credential | DDS
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Telephone | 812-522-7360
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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 | 12005390A
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License Number State | IN
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