Individual
DR. THOMAS JAGGERS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5805 W HIGHWAY 22, CRESTWOOD, KY 40014-7244
(502) 241-7116
(502) 241-2339
Mailing address
5805 W HIGHWAY 22, CRESTWOOD, KY 40014-7244
(502) 241-7116
(502) 241-2339
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4571
KY
1223G0001X
General Practice Dentistry
Primary
4571
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60045713
—
KY
Enumeration date
08/24/2006
Last updated
09/11/2025
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