Kelly Clark

NPI #1942379458 in Decatur, Illinois

Provider Information

NPI Number: 1942379458
Entity Type: Individual
Name: Kelly Clark
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 7, 2006
Last Updated: Apr 21, 2010

Practice Location

Address: 3737 E RTE 36
City: Decatur
State: Illinois
ZIP Code: 62521-5028
Phone: (217) 423-2400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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