| Dr Clark K J Pc | |
|
128 S Locust St Pana IL 62557-1430 | |
| (217) 562-3330 | |
| Not Available |
| Full Name | Dr Clark K J Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 128 S Locust St, Pana, Illinois |
| Authorized Official Name and Position | Kelly Clark (PRESIDENT) |
| Authorized Official Contact | 2175623330 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Clark K J Pc 128 S Locust St Pana IL 62557-1430 Ph: () - | Dr Clark K J Pc 128 S Locust St Pana IL 62557-1430 Ph: (217) 562-3330 |
| NPI Number | 1598193153 |
|---|---|
| Provider Enumeration Date | 10/17/2013 |
| Last Update Date | 10/17/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598193153 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019026315 (Illinois) | Primary |