Individual
DR. STEPHEN JETER CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY, 501 S. PRESTON ST., LOUISVILLE, KY 40292-0001
(502) 852-5128
(502) 852-7163
Mailing address
UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY, 501 S. PRESTON ST., LOUISVILLE, KY 40292-0001
(502) 852-5128
(502) 852-7163
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
4107
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60041076
—
KS
Enumeration date
09/06/2006
Last updated
07/08/2007
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