Individual
DR. JEFFREY D DOMARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
1550 TOMCAT BLVD, SUITE 150, VIRGINIA BEACH, VA 23460-2188
(757) 953-3926
Mailing address
1550 TOMCAT BLVD, SUITE 150, VIRGINIA BEACH, VA 23460-2188
(757) 953-3926
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019-026178
IL
122300000X
Dentist
Primary
2010010741
MO
1223E0200X
Endodontics
0401413366
VA
Other
Enumeration date
01/23/2006
Last updated
12/09/2011
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