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NPI Code Detail

MEDICARE: DR. LYNN ROBINSON CLARK DDS

MEDICARE:  DR. LYNN ROBINSON CLARK  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist0401005811VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10401005811OTHERVADENTAL LICENSE NUMBER

General Provider Information

NPI Number : 1033269824
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYNN ROBINSON CLARK DDS
Provider Business Mailing Address
First Line : 3310 FRANKLIN RD SW
Second Line :
City : ROANOKE
State : VA
Zip : 24014-1310
Country : US
Telephone Number : 540-342-7221
Fax Number : 540-400-8304
Provider Business Practice Location Address
First Line : 3310 FRANKLIN RD SW
Second Line :
City : ROANOKE
State : VA
Zip : 24014-1310
Country : US
Telephone Number : 540-342-7221
Fax Number : 540-400-8304
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 07/08/2007

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Directions to “ DR. LYNN ROBINSON CLARK DDS” Practice Location

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