Basic Information
| Provider Information | |||||||||
| NPI: | 1114087616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARTHUR | ||||||||
| FirstName: | CLARK | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W NIFONG BLVD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652036804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734491918 | ||||||||
| FaxNumber: | 5738173161 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W NIFONG BLVD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652036804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734491918 | ||||||||
| FaxNumber: | 5738173161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 13889 | MO | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 029190 | 01 | KS | BCBS | OTHER | 114091 | 01 | MO | UNITED CONCORDIA | OTHER |