Gregory Dale Clark, D.D.S.
Individual provider Active NPI General Practice Dentistry · Oakwood, GA
NPI 1114064797 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1114064797
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 8846 (GA)
- Practice address
- 4212 McEver Rd
Oakwood, GA 30566-2237 - Phone
- (770) 534-1816
- Fax
- (770) 534-3059
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8846 | GA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8846 | GA | Yes |
Addresses
Primary practice location
4212 McEver Rd
Oakwood, GA 30566-2237
Mailing address
4212 McEver Road
Oakwood, GA 30566
Phone (770) 534-4663
Other providers in Oakwood, GA
- Susan Elaine Carpenter
- Jeffrey C Carstens
- Maria Luz Chavez
- Matthew Alexander Chin
- Chocolate Healing Arts Center
- Karla Cocom Jaynes
- David Leonard Cohen
- Donna Marie Colavecchio
- Michael J Collier
- Linda S Collins
All providers in Oakwood, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.