Provider Demographics
NPI:1285937912
Name:J. DARON CLARK, DMD, PC
Entity type:Organization
Organization Name:J. DARON CLARK, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:DARON
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-254-1393
Mailing Address - Street 1:101 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1302
Mailing Address - Country:US
Mailing Address - Phone:615-254-1393
Mailing Address - Fax:615-313-3666
Practice Address - Street 1:101 UNION ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37201-1302
Practice Address - Country:US
Practice Address - Phone:615-254-1393
Practice Address - Fax:615-313-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty