Doctor Name: | DR. KATHERINE ELIZABETH CLARK |
NPI Number: | 1194749978 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DMD |
License Number: | 4123 |
Business Practice Address: | 130 Ben Casey Dr Suite 105 Fort Mill, SC - 297086567 |
Business Phone Number: | 8035478200 |
Business Fax Number: | |
Mailing Address: | 130 Ben Casey Dr, Suite 105 FORT MILL |
State: | SC |
Postal Code: | 297086567 |
Phone Number: | 8035478200 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2006 |
NPI Last Update Date: | 07/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 4123 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |