MEDICARE: CLARK-AYIK DENTAL WESTLAKE PLLC

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1699012021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK-AYIK DENTAL WESTLAKE PLLC

Provider Business Mailing Address
First Line	:	2785 BEE CAVE RD
Second Line	:	SUITE 331
City	:	ROLLINGWOOD
State	:	TX
Zip	:	78746-5798
Country	:	US
Telephone Number	:	512-782-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	2785 BEE CAVE RD
Second Line	:	SUITE 331
City	:	ROLLINGWOOD
State	:	TX
Zip	:	78746-5798
Country	:	US
Telephone Number	:	512-782-0820
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	ASHLEY HOLLIS
Credential	:
Telephone Number	:	972-854-2960

Provider Enumeration Date	:	01/04/2013
Last Update Date	:	01/04/2013

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