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General NPI Number Information
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NPI Number | 1992767545
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Entity Type | Individual
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Provider Name | LARA MARGARET CLARK D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 28626 TELEGRAPH RD
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1934
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Country | US
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Telephone | 947-237-6421
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Fax |
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Provider Business Mailing Address
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Address Line | 49062 HONEY TREE CT
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City | NORTHVILLE
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State | MI
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Zip | 48168-8601
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Country | US
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Telephone | 919-434-9586
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 9245
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901602475
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License Number State | MI
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