Provider Demographics
NPI:1093863110
Name:CLARK, HARRY ALBERT JR (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ALBERT
Last Name:CLARK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22A MILLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4249
Mailing Address - Country:US
Mailing Address - Phone:717-291-1271
Mailing Address - Fax:717-291-1272
Practice Address - Street 1:22A MILLERSVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4249
Practice Address - Country:US
Practice Address - Phone:717-291-1271
Practice Address - Fax:717-291-1272
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019957L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice