Individual
DR. JENNIFER L. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MSD
Contact information
Practice address
1279 E 1ST AVE STE D, CHICO, CA 95926-1542
(530) 809-2379
Mailing address
1279 E 1ST AVE STE D, CHICO, CA 95926-1542
(530) 520-8401
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
59915
CA
1223P0300X
Periodontics
Primary
DD4420
NM
1223P0300X
Periodontics
DEN.00202055
CO
Other
Enumeration date
10/22/2012
Last updated
12/08/2021
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