MEDICARE: KATHERINE ANNE 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
1	122300000X	Dentist	41822	TX

General Provider Information

NPI Number	:	1730064114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANNE CLARK DDS

Provider Business Mailing Address
First Line	:	101 E GLADE RD APT 9201
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-7392
Country	:	US
Telephone Number	:	225-241-2856
Fax Number	:

Provider Business Practice Location Address
First Line	:	2246 JACKSBORO HWY STE 112
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-2363
Country	:	US
Telephone Number	:	817-529-1799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	08/06/2025

Similar Medicare Providers

1861706012 — DR. WILLIAM FIORE DMD
Practice Location Address:

2246 JACKSBORO HWY STE 122
FORT WORTH, TX
76114-2363

Practice Phone: 817-529-1799
Practice Fax:

1477405439 — GRACEFUL HOME CARE SERVICES, LLC
Practice Location Address:

2363 SHIMMERY LN
LAKE WORTH, FL
33462-6001

Practice Phone: 516-738-1511
Practice Fax:

1780360099 — JORDAN ROMEO OTR/L
Practice Location Address:

4180 SAGE BLUFF XING
FORT WAYNE, IN
46804-2363

Practice Phone: 260-443-7300
Practice Fax:

1871899500 — LINDSAY WILSON
Practice Location Address:

4180 SAGE BLUFF XING
FORT WAYNE, IN
46804-2363

Practice Phone: 260-443-7300
Practice Fax:

1588934285 — DR. JACOB NUDEL M.D.
Practice Location Address:

333 LAS OLAS WAY , APT 3703
FORT LAUDERDALE, FL
33301-2363

Practice Phone: 954-980-9998
Practice Fax:

1346582087 — DR. LINDA LEE CIVERCHIA M.D.
Practice Location Address:

333 LAS OLAS WAY 210
FORT LAUDERDALE, FL
33301-2363

Practice Phone: 954-235-3220
Practice Fax: 954-523-5429

Directions to “ KATHERINE ANNE CLARK DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.