Kelly Clark DDS PC

NPI #1982839056 in Decatur, Illinois

Provider Information

NPI Number: 1982839056
Entity Type: Organization
Organization Name: Kelly Clark DDS PC
Primary Specialty: Dentist - General Practice
Enumeration Date: May 19, 2009
Last Updated: May 19, 2009

Practice Location

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

Authorized Official

Name: KELLY CLARK
Title: OWNER/PRESIDENT
Phone: (217) 423-2400

Specialties & Taxonomy Codes

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

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