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Individual

DR. JASON DREW CLARK

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
7810 PROVIDENCE RD, SUITE 100, CHARLOTTE, NC 28226-2987
(704) 543-3766
(704) 543-3768
Mailing address
7810 PROVIDENCE RD, SUITE 100, CHARLOTTE, NC 28226-2987
(704) 543-3766
(704) 543-3768

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6966
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8990141
NC
Enumeration date
03/29/2006
Last updated
07/08/2007
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