Clark, Patricia

Clark, Patricia is an individual health care provider with primary practice located at 221 S 19Th St , Terre Haute IN 47807-4129. She recently has only one registered license in Dental Providers / Endodontics, which is considered as her primary health care specialty. Clark, Patricia can be contacted via phone (812) 235-1598.

Contact Information

Primary practice address
221 S 19Th St Terre Haute IN 47807-4129
Phone: (812) 235-1598
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Endodontics 1223E0200X 7844 Indiana

Profile Details

NPI number 1306140447
LBN Legal business name Clark, Patricia
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 4th, 2011
Last updated Jan 4th, 2011 - 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 1306140447 NPPES
Indiana MEDICAID 100065720A

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