Criston C. Clark, D.M.D.
Individual provider Active NPI Dentist · Ringgold, GA
NPI 1740420629 · NPPES record last updated Mar 4, 2009
Key facts
- NPI
- 1740420629
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 011280 (GA)
- Practice address
- 7102 Nashville St
Ringgold, GA 30736-2446 - Phone
- (706) 965-7272
- Fax
- (706) 965-7279
- NPI assigned
- Mar 4, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 011280 | GA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 011280 | GA | Yes |
Addresses
Primary practice location
7102 Nashville St
Ringgold, GA 30736-2446
Mailing address
PO Box 934
Ringgold, GA 30736-0934
Phone (706) 965-7272
Other providers in Ringgold, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2009. 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.