| L L Clark Dds Sc | |
|
105 East Bluff Street Boscobel WI 53805-9802 | |
| (608) 375-4549 | |
| (608) 375-4665 |
| Full Name | L L Clark Dds Sc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 105 East Bluff Street, Boscobel, Wisconsin |
| Authorized Official Name and Position | Larry Lee Clark (DENTIST) |
| Authorized Official Contact | 6083754549 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| L L Clark Dds Sc 105 East Bluff Street Boscobel WI 53805-9802 Ph: (608) 375-4549 | L L Clark Dds Sc 105 East Bluff Street Boscobel WI 53805-9802 Ph: (608) 375-4549 |
| NPI Number | 1497713176 |
|---|---|
| Provider Enumeration Date | 05/03/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497713176 | NPI | - | NPPES |
| 33549200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5001678015 (Wisconsin) | Primary |
Boscobel Family Dental Care Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 E Bluff St, Boscobel, WI 53805 Phone: 608-375-4549 | |
Formerly Self Proprietor Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 Parker Street, Boscobel, WI 53805 Phone: 608-375-4640 | |
Boscobel Family Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 E. Bluff Street, Boscobel, WI 53805 Phone: 608-375-4549 Fax: 608-375-4665 |