L L Clark DDS SC
Organization Active NPI General Practice Dentistry · Boscobel, WI
NPI 1497713176 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1497713176
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5001678015 (WI)
- Legal business name
- L L CLARK DDS SC
- Practice address
- 105 East Bluff Street
Boscobel, WI 53805-9802 - Phone
- (608) 375-4549
- Fax
- (608) 375-4665
- NPI assigned
- May 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Larry Lee Clark, DDS
- Title
- Dentist
- Phone
- (608) 375-4549
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | 5001678015 | WI | Yes |
Addresses
Primary practice location
105 East Bluff Street
Boscobel, WI 53805-9802
Mailing address
105 East Bluff Street
Boscobel, WI 53805-9802
Phone (608) 375-4549
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33549200 | Medicaid | WI |
Other providers in Boscobel, WI
- Jones Family Chiropractic, LLC
- Nicolle Kass
- Maria R Kindrai
- Melissa R Knutson
- Jennifer Lynn Kruger
- Alissa S Lange
- Stacey Inez Larson
- Amber Leahy
- Joel Spencer Ledvina
- Joyce Elaine Leis
All providers in Boscobel, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.