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General NPI Number Information
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NPI Number | 1992336127
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Entity Type | Organization
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Legal Business Name | DEVIN CLARK, DDS, PLLC
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 617 CEMETERY RD STE A
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City | WINLOCK
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State | WA
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Zip | 98596-9303
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Country | US
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Telephone | 360-785-4655
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Fax | 360-785-3336
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Provider Business Mailing Address
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Address Line | PO BOX 399
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City | WINLOCK
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State | WA
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Zip | 98596-0399
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Country | US
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Telephone | 360-785-4755
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Fax | 360-785-3336
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. DEVIN CLARK
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Credential | DDS
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Telephone | 801-808-3375
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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 |
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License Number State |
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