Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KELLY CLARK
ActiveKELLY CLARK is a General Dentistry healthcare provider located in DECATUR, Illinois. NPI 1942379458 is currently active in the NPPES registry. Verify at CMS.
General Dentistry · DECATUR, IL
Registration Details
- NPI Number
- 1942379458
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Nov 7, 2006 (19.782612940345 yrs)
- Last Updated
- Apr 21, 2010
- License
-
019026315 (IL)
Practice Information
- Address
-
3737 E RTE 36DECATUR, IL, 625215028Browse IL providers · Browse ZIP 62521
- Phone
- 2174232400
- Fax
- 2174232460
- Primary Specialty
-
General Dentistry
1223G0001X
Other General Dentistry Providers in DECATUR, IL
| Name | Credential | NPI |
|---|---|---|
| ALAN COLBY | DDS | 1578532099 |
| DR. RICKY DEAN SIMMS | DMD | 1013931161 |
| DR. JERRY R HARRISON | DMD | 1295825602 |
| DR. KEVIN MARCELLINO ARTIME | KEVIN ARTIME DMD | 1770655540 |
| SCOTT T GAITROS | DMD | 1376609354 |
| DR. RONALD N. COLE | DMD | 1942354592 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.