Provider Demographics
NPI:1083053029
Name:MORRIS, CLARK LOGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:LOGAN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2800 WAKEFIELD PINES DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614
Mailing Address - Country:US
Mailing Address - Phone:919-570-0180
Mailing Address - Fax:919-570-0280
Practice Address - Street 1:2800 WAKEFIELD PINES DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-570-0180
Practice Address - Fax:919-570-0280
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0442000185122300000X
NC99271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083053029Medicaid