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DR. CHESTER VAN CLARK D.D.S., M.P.H.

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1750653127

Individual Registrant:
DR. CHESTER VAN CLARK D.D.S., M.P.H.
Gender: M
Sole Proprietor

Location and contact information for practice:
439 E THOMPSON ST  AMITY, AR 71921-8602 US
Tel: 870-342-5265  Fax: 870-342-6292

Contact information for business:
439 E THOMPSON ST  AMITY, AR 71921-8602 US
Tel: 870-342-5265  Fax: 870-342-6292

Registration Information:
NPI: 1750653127
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
ARAR2228

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
101460608AR05




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