| Travis Clark Dds Llc | |
|
1248 Columbus Ave Ste 8 Lebanon OH 45036-9005 | |
| (513) 932-0432 | |
| (513) 932-0152 |
| Full Name | Travis Clark Dds Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1248 Columbus Ave Ste 8, Lebanon, Ohio |
| Authorized Official Name and Position | Travis Clark (DENTIST) |
| Authorized Official Contact | 6149370509 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Travis Clark Dds Llc 7845 Plantation Dr Mason OH 45040-5944 Ph: (614) 937-0509 | Travis Clark Dds Llc 1248 Columbus Ave Ste 8 Lebanon OH 45036-9005 Ph: (513) 932-0432 |
| NPI Number | 1093329914 |
|---|---|
| Provider Enumeration Date | 09/08/2020 |
| Last Update Date | 09/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093329914 | NPI | - | NPPES |
| 2668466 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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