Clark, John Nicholas

Clark, John Nicholas is an individual health care provider with primary practice located at 810 Locust St , Conway AR 72034-5331. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Clark, John Nicholas can be contacted via phone (479) 466-3834.

Contact Information

Primary practice address
810 Locust St Conway AR 72034-5331
Phone: (479) 466-3834
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 3810 Arkansas

Profile Details

NPI number 1649401597
LBN Legal business name Clark, John Nicholas
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2009
Last updated Oct 1st, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649401597 NPPES
Arkansas MEDICAID 187121608

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