# JEFFREY CLARK

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942330782
- **Authorized official:** DR. JEFFREY B CLARK DDS (OWNER)
- **Authorized official phone:** (785) 273-2565

## Contact information

- **Practice address:** 5990 SW 28TH ST, SUITE D, TOPEKA, KS 66614-2545
- **Practice address phone:** (785) 273-2565
- **Practice address fax:** (785) 273-2567
- **Mailing address:** 5990 SW 28TH ST., SUITE D, TOPEKA, KS 66614-3525
- **Mailing address phone:** (785) 273-2565
- **Mailing address fax:** (785) 273-2567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 60087 | KS | Yes |

## Other

- **Enumeration date:** 03/07/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 116611 | BLUE CROSS | KS |