Provider Demographics
NPI:1699717769
Name:CLARK, STEPHEN CHRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHRIS
Last Name:CLARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7200 S PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-3336
Mailing Address - Country:US
Mailing Address - Phone:405-681-6668
Mailing Address - Fax:405-682-6609
Practice Address - Street 1:7200 S PENNSYLVANIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-3336
Practice Address - Country:US
Practice Address - Phone:405-681-6668
Practice Address - Fax:405-682-6609
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK 41001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice