MEDICARE: CLARK HEPWORTH 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	1223G0001X	General Practice Dentistry	33238	TX

General Provider Information

NPI Number	:	1891217295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARK HEPWORTH DDS

Provider Business Mailing Address
First Line	:	4502 HAWTHORN WOODS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1486
Country	:	US
Telephone Number	:	913-530-8581
Fax Number	:

Provider Business Practice Location Address
First Line	:	4965 W COMMERCE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-1508
Country	:	US
Telephone Number	:	210-702-3206
Fax Number	:

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

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	07/07/2017

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