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Individual
DR. JEFFREY D DOMARK
Active
Individual
DR. JEFFREY D DOMARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019-026178
IL
122300000X
Dentist
Primary
2010010741
MO
1223E0200X
Endodontics
0401413366
VA
Other
Enumeration date
01/23/2006
Last updated
12/09/2011
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