L L Clark Dds Sc | |
105 East Bluff Street Boscobel WI 53805-9802 | |
(608) 375-4549 | |
(608) 375-4665 |
Full Name | L L Clark Dds Sc |
---|---|
Speciality | Dentist - General Practice |
Location | 105 East Bluff Street, Boscobel, Wisconsin |
Authorized Official Name and Position | Larry Lee Clark (DENTIST) |
Authorized Official Contact | 6083754549 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
L L Clark Dds Sc 105 East Bluff Street Boscobel WI 53805-9802 Ph: (608) 375-4549 | L L Clark Dds Sc 105 East Bluff Street Boscobel WI 53805-9802 Ph: (608) 375-4549 |
NPI Number | 1497713176 |
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Provider Enumeration Date | 05/03/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497713176 | NPI | - | NPPES |
33549200 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 5001678015 (Wisconsin) | Primary |
Boscobel Family Dental Care Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 E Bluff St, Boscobel, WI 53805 Phone: 608-375-4549 | |
Formerly Self Proprietor Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 Parker Street, Boscobel, WI 53805 Phone: 608-375-4640 | |
Boscobel Family Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 E. Bluff Street, Boscobel, WI 53805 Phone: 608-375-4549 Fax: 608-375-4665 |