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Individual
DR. EDFORD LEON CLARK JR.
Active
Individual
DR. EDFORD LEON CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5490
KY
1223G0001X
General Practice Dentistry
5490
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143184
BCBS OF VA
VA
01
—
3147483
BCBS OF TN
—
01
—
322610
TIEGEN BCBS
—
01
—
401559
UNITED CONCORDIA
—
05
—
6005L905
—
KY
01
—
66083861
BCBS OF AL
—
01
—
E914
FEDERAL BCBS
—
Enumeration date
06/07/2006
Last updated
12/10/2012
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