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Kelly Clark
General Practice Dentistry in Decatur, Illinois
NPI 1942379458

Kelly Clark is a General Practice Dentistry based in Mt Zion, IL and is specialized in General Practice. Kelly Clark practices in Decatur, IL. The NPI Number for Kelly Clark is 1942379458 and holds a License No. 019026315 (Illinois).

The current practice location address for Kelly Clark is 3737 E Rte 36, Decatur, IL and can be reached out via phone at 217-423-2400 and via fax at 217-423-2460.

Location: 3737 E Rte 36, Decatur, IL, 62549-1183
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1942379458
Provider Name
Kelly Clark
Credential
Provider Entity Type
Individual
Gender
Male
Address
3737 E Rte 36, Decatur, IL, 62549-1183
Phone Number
217-423-2400
Fax Number
217-423-2460
Provider Enumeration Date
11/07/2006
Last Update Date
03/08/2024
institution
Provider Business Practice Location Address Details
Address
3737 E Rte 36
City
Decatur
State
Illinois
Zip
62521-5028
Phone Number
217-423-2400
Fax Number
217-423-2460
person
Provider Business Mailing Address Details
Address
3737 E Rte 36
City
Decatur
State
Illinois
Zip
62521-5028
Phone Number
217-423-2400
Fax Number
217-423-2460
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
019026315 (Illinois)
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
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