Provider Demographics
NPI:1992922454
Name:CLARK, CHRISTOPHER B (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:B
Last Name:CLARK
Suffix:
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 1:28321 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-4164
Mailing Address - Country:US
Mailing Address - Phone:419-874-3333
Mailing Address - Fax:419-874-9573
Practice Address - Street 1:28321 KENSINGTON LN
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-4164
Practice Address - Country:US
Practice Address - Phone:419-874-3333
Practice Address - Fax:419-874-9573
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH194121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice