# DR. EDFORD LEON CLARK JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1710927785
- **Gender:** Man
- **Credential:** DMD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5490 | KY | Yes |
| 1223G0001X | General Practice Dentistry | 5490 | KY | — |

## Other

- **Enumeration date:** 06/07/2006
- **Last updated:** 12/10/2012

## 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 | — |